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General NPI Number Information
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NPI Number | 1265981666
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Entity Type | Organization
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Legal Business Name | YOUR NEIGHBORHOOD DENTAL CARE LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 3306 W ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85009-3404
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Country | US
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Telephone | 602-889-9401
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Fax | 602-889-9404
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Provider Business Mailing Address
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Address Line | 3306 W ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85009-3404
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Country | US
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Telephone | 602-889-9401
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Fax | 602-889-9404
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MICHELLE REHNBERG
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Credential |
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Telephone | 602-889-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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