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General NPI Number Information
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NPI Number | 1487974333
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Entity Type | Organization
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Legal Business Name | DESERT ROSE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 8675 S PRIEST DR STE 101
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City | TEMPE
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State | AZ
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Zip | 85284-1914
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Country | US
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Telephone | 480-961-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 8675 S PRIEST DR STE 101
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City | TEMPE
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State | AZ
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Zip | 85284
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Country | US
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Telephone | 480-961-0600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RIMA PETERS
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Credential | DMD
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Telephone | 480-961-0600
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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 | D6169
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License Number State | AZ
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