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General NPI Number Information
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NPI Number | 1295190072
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Entity Type | Organization
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Legal Business Name | VENTANA FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 20403 N LAKE PLEASANT RD SUITE 121
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City | PEORIA
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State | AZ
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Zip | 85382-9702
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Country | US
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Telephone | 623-566-1200
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Fax | 623-566-0114
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Provider Business Mailing Address
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Address Line | 20403 N LAKE PLEASANT RD SUITE 121
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City | PEORIA
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State | AZ
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Zip | 85382-9702
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Country | US
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Telephone | 623-566-1200
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Fax | 623-566-0114
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | CRAIG THOMPSON
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Credential |
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Telephone | 623-566-1200
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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 | D4654
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License Number State | AZ
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