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General NPI Number Information
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NPI Number | 1760756209
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Entity Type | Organization
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Legal Business Name | PEORIA DENTAL CENTER GROUP, LLC
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 8914 N 91ST AVE STE 115
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City | PEORIA
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State | AZ
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Zip | 85345-8390
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Country | US
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Telephone | 623-877-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 8914 N 91ST AVE STE 115
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City | PEORIA
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State | AZ
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Zip | 85345-8390
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Country | US
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Telephone | 623-877-5700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RASOUL SALIM
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Credential |
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Telephone | 623-877-5700
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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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