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General NPI Number Information
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NPI Number | 1790443455
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Entity Type | Organization
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Legal Business Name | BUCKEYE MODERN DENTISTRY, LLP
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 946 S WATSON RD STE 101
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City | BUCKEYE
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State | AZ
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Zip | 85326-3430
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Country | US
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Telephone | 623-267-4676
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Fax | 623-505-1128
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DON PARKER
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Credential | DDS
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Telephone | 623-267-4676
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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 |
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License Number State |
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