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General NPI Number Information
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NPI Number | 1598506768
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Entity Type | Organization
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Legal Business Name | 51ST DMSO LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE STE 162
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City | GLENDALE
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State | AZ
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Zip | 85308-4624
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Country | US
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Telephone | 623-303-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 2735 S ALMA SCHOOL RD STE 1
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City | CHANDLER
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State | AZ
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Zip | 85286-4404
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Country | US
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Telephone | 702-525-4500
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. ANDREA FROST
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Credential |
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Telephone | 702-771-0015
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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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