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General NPI Number Information
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NPI Number | 1285576058
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Entity Type | Organization
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Legal Business Name | BISMARK LAKE LLC
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 14175 W INDIAN SCHOOL RD STE B6
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City | GOODYEAR
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State | AZ
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Zip | 85395-8490
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Country | US
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Telephone | 602-902-0275
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Fax |
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Provider Business Mailing Address
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Address Line | 1786 S 141ST PL
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City | GILBERT
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State | AZ
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Zip | 85295-4752
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL HUNT
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Credential |
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Telephone | 480-280-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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