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General NPI Number Information
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NPI Number | 1740614189
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Entity Type | Organization
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Legal Business Name | AZ DENTAL, INC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 515 N 35TH AVE STE 122
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City | PHOENIX
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State | AZ
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Zip | 85009-3339
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Country | US
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Telephone | 602-455-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 515 N 35TH AVE STE 122
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City | PHOENIX
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State | AZ
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Zip | 85009-3339
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Country | US
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Telephone | 602-455-0505
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Fax |
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Authorized Official
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Title or Position | CEO AND OWNER
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Name | BRIAN NGOC TONG
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Credential | DDS
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Telephone | 602-455-0505
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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 | D6451
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License Number State | AZ
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