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General NPI Number Information
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NPI Number | 1477388213
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Entity Type | Organization
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Legal Business Name | PHOENICIA DENTAL GROUP, PC
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 14150 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 623-536-2040
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Fax | 623-536-8555
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Provider Business Mailing Address
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Address Line | 14150 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 623-536-2040
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Fax | 623-536-8555
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE AYOUB
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Credential | D.D.S
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Telephone | 623-536-2040
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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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