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General NPI Number Information
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NPI Number | 1285041020
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Entity Type | Organization
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Legal Business Name | WESTERN DENTAL OF ARIZONA, INC.
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 1348 E FLORENCE BLVD 7
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5361
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Country | US
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Telephone | 520-316-4287
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Fax | 520-316-4291
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Provider Business Mailing Address
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Address Line | 530 S MAIN ST
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City | ORANGE
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State | CA
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Zip | 92868-4525
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Country | US
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Telephone | 714-480-3000
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Fax | 714-571-6445
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Authorized Official
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Title or Position | PPO COORDINATOR
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Name | SOLEDAD NAVARRO
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Credential |
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Telephone | 714-480-3000
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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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