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General NPI Number Information
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NPI Number | 1467179325
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Entity Type | Organization
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Legal Business Name | IT'S YOUR TIME DENTAL
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 21295 S ELLSWORTH LOOP RD STE 103
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9867
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Country | US
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Telephone | 480-571-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 22450 S 201ST CT
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6311
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Country | US
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Telephone | 530-966-2011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT ELLIS PARROTT
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Credential | DDS
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Telephone | 530-966-5335
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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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