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General NPI Number Information
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NPI Number | 1720167190
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Entity Type | Organization
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Legal Business Name | A 101 DENTAL CARE PC
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2899 N 87TH STREET #100
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City | SCOTTSDALE
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State | AZ
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Zip | 85257
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Country | US
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Telephone | 480-423-1000
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Fax | 480-423-1002
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Provider Business Mailing Address
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Address Line | 2899 N 87TH STREET #100
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City | SCOTTSDALE
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State | AZ
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Zip | 85257
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Country | US
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Telephone | 480-423-1000
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Fax | 480-423-1002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICK NOZAR MANSOURIAN
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Credential | DDS
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Telephone | 480-423-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | AZ4613
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License Number State | AZ
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