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General NPI Number Information
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NPI Number | 1689819062
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Entity Type | Organization
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Legal Business Name | PARADISE VALLEY ENDODONTIC GROUP, PLLC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 10585 N TATUM BLVD D-132
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1073
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Country | US
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Telephone | 480-483-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 10585 N TATUM BLVD D-132
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1073
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Country | US
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Telephone | 480-483-9001
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JACQUELINE S ALLEN
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Credential | D.D.S.,M.S.
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Telephone | 480-483-9001
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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 | 4952
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License Number State | AZ
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