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General NPI Number Information
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NPI Number | 1639622103
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Entity Type | Organization
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Legal Business Name | AZCDC,LLC
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 5700 W OLIVE AVE
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City | GLENDALE
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State | AZ
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Zip | 85302
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Country | US
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Telephone | 480-226-5652
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Fax |
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Provider Business Mailing Address
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Address Line | POBOX 5132
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City | PEORIA
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State | AZ
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Zip | 85385
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Country | US
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Telephone | 480-226-5652
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Fax |
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Authorized Official
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Title or Position | DENTIS
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Name | DR. JOAN L FOX
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Credential |
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Telephone | 480-226-5652
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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 | DD4407
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D4274
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License Number State | AZ
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