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General NPI Number Information
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NPI Number | 1386847218
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Entity Type | Organization
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Legal Business Name | ARIZONA DENTAL HEALTH, INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 2500 S. POWER RD. STE. 105
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City | MESA
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State | AZ
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Zip | 85209
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Country | US
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Telephone | 480-926-1899
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Fax | 480-926-3177
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Provider Business Mailing Address
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Address Line | 2500 S. POWER RD. STE 105
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City | MESA
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State | AZ
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Zip | 85209
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Country | US
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Telephone | 480-926-1899
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Fax | 480-926-3177
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS JEFFREY BRIAN PICO
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Credential | DDS
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Telephone | 480-926-1899
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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 | 4229
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License Number State | AZ
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