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General NPI Number Information
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NPI Number | 1467929448
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Entity Type | Organization
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Legal Business Name | GANTZEL DENTAL CENTER
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 36327 N GANTZEL RD STE 104
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7328
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Country | US
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Telephone | 480-818-3177
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Fax |
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Provider Business Mailing Address
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Address Line | 36327 N GANTZEL RD STE 104
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7328
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Country | US
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Telephone | 480-818-3177
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES WESLEY CULLER
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Credential | DMD
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Telephone | 480-818-3177
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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 |
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License Number State |
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