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General NPI Number Information
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NPI Number | 1679927958
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Entity Type | Organization
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Legal Business Name | EPIC FAMILY DENTAL CARE BETHANY
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 2101 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-1936
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Country | US
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Telephone | 602-249-4453
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Fax | 480-249-9270
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Provider Business Mailing Address
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Address Line | 2101 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-1936
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Country | US
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Telephone | 602-249-4453
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Fax | 480-249-9270
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | CLAUDIA RUIZ
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Credential |
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Telephone | 602-249-4453
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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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