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General NPI Number Information
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NPI Number | 1548320609
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL SERVICES OF AZ
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 201 S 36TH ST
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City | PHOENIX
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State | AZ
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Zip | 85034
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Country | US
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Telephone | 602-434-8699
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Fax | 602-391-2380
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Provider Business Mailing Address
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Address Line | 201 S 36TH ST
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City | PHOENIX
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State | AZ
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Zip | 85034
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Country | US
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Telephone | 602-434-8699
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Fax | 602-391-2380
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. ELIZABETH LOELKE
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Credential |
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Telephone | 602-434-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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