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General NPI Number Information
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NPI Number | 1841536612
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Entity Type | Organization
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Legal Business Name | AZ LIFETIME DENTISTRY LLC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 13065 W MCDOWELL RD STE 112
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City | AVONDALE
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State | AZ
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Zip | 85392-6439
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Country | US
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Telephone | 623-455-6958
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Fax |
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Provider Business Mailing Address
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Address Line | 11445 E VIA LINDA STE 2422
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2655
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Country | US
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Telephone | 480-544-2240
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. GINA MICHELLE ELROD
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Credential | D.D.S.
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Telephone | 480-544-2240
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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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