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General NPI Number Information
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NPI Number | 1316167216
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Entity Type | Organization
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Legal Business Name | CONTINENTAL DENTAL CARE MILL AVENUE LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2210 S MILL AVE STE 2
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City | TEMPE
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State | AZ
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Zip | 85282-2153
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Country | US
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Telephone | 480-921-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 122 SKYVIEW DRIVE
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City | BELLEFONTE
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State | PA
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Zip | 16823
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Country | US
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Telephone | 814-355-2945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK EICH
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Credential |
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Telephone | 480-921-2434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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