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General NPI Number Information
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NPI Number | 1598262917
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Entity Type | Organization
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Legal Business Name | A TENDER DENTAL CARE V LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 25355 N LAKE PLEASANT PKWY UNIT 103
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City | PEORIA
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State | AZ
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Zip | 85383-1504
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Country | US
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Telephone | 480-824-8165
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Fax |
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Provider Business Mailing Address
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Address Line | 25355 N LAKE PLEASANT PKWY UNIT 103
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City | PEORIA
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State | AZ
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Zip | 85383-1504
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Country | US
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Telephone | 480-824-8165
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JASON A WANG
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Credential |
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Telephone | 480-824-8165
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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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