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General NPI Number Information
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NPI Number | 1265734701
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Entity Type | Organization
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Legal Business Name | EAST VALLEY ENDODONTICS
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 18610 E RITTENHOUSE RD # A-104
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4503
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Country | US
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Telephone | 480-988-0020
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Fax | 480-988-6208
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Provider Business Mailing Address
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Address Line | 18610 E RITTENHOUSE RD # A-104
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4503
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Country | US
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Telephone | 480-988-0020
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Fax | 480-988-6208
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN L FROST
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Credential | D.D.S.
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Telephone | 480-988-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D4318
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License Number State | AZ
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