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General NPI Number Information
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NPI Number | 1760076145
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Entity Type | Organization
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Legal Business Name | DENTAL DEPOT ORTHO GREENWAY PLLC
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 3750 W GREENWAY RD
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City | PHOENIX
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State | AZ
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Zip | 85053-3703
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Country | US
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Telephone | 602-466-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 NW 30TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7404
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Country | US
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Telephone | 602-312-2752
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | RUTH MARTINEZ
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Credential |
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Telephone | 602-312-2752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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