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General NPI Number Information
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NPI Number | 1750712642
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Entity Type | Organization
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Legal Business Name | PDO LLC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 4146 NEUMAN RD
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City | SAINT CLAIR
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State | MI
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Zip | 48079-3234
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Country | US
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Telephone | 480-775-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 2995 W ELLIOT RD STE 1
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City | CHANDLER
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State | AZ
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Zip | 85224-1670
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Country | US
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Telephone | 480-775-8600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED POPE
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Credential | DDS
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Telephone | 480-332-6111
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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 |
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License Number State |
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