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General NPI Number Information
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NPI Number | 1427077619
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Entity Type | Organization
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Legal Business Name | VICTOR COSMETIC AND FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8663 W UNION HILLS DR SUTE #400
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City | PEORIA
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State | AZ
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Zip | 85382-7004
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Country | US
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Telephone | 623-933-8500
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Fax | 623-933-8501
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Provider Business Mailing Address
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Address Line | 8663 W UNION HILLS DR SUTE #400
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City | PEORIA
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State | AZ
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Zip | 85382-7004
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Country | US
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Telephone | 623-933-8500
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Fax | 623-933-8501
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. VICKI LYNN CURRY
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Credential |
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Telephone | 623-933-8500
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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 | 5440
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License Number State | AZ
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