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General NPI Number Information
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NPI Number | 1760125504
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Entity Type | Organization
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Legal Business Name | BLUEBIRD PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 1520 W WARNER RD STE 110
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City | GILBERT
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State | AZ
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Zip | 85233-7043
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Country | US
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Telephone | 615-410-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 N CENTRAL AVE APT 3189
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City | PHOENIX
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State | AZ
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Zip | 85004-1672
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | ARLENE KEWALLAL
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Credential | DDS
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Telephone | 615-410-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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