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General NPI Number Information
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NPI Number | 1346322260
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Entity Type | Organization
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Legal Business Name | PASEO DENTAL PLLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 04/10/2010
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Provider Practice Location Address
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Address Line | 6120 WEST BELL RD SUITE 190
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City | GLENDALE
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State | AZ
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Zip | 85308-3786
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Country | US
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Telephone | 602-978-3878
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Fax | 602-978-1481
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Provider Business Mailing Address
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Address Line | 6120 WEST BELL RD SUITE 190
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City | GLENDALE
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State | AZ
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Zip | 85308-3786
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Country | US
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Telephone | 602-978-3878
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Fax | 602-978-1481
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Authorized Official
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Title or Position | MEMBER
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Name | DR. OUT OF BUSINESS
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Credential | DMD
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Telephone | 602-978-3878
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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 | 2607
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License Number State | AZ
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