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General NPI Number Information
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NPI Number | 1891339727
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Entity Type | Organization
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Legal Business Name | DENTAL INNOVATIONS
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 160 S POWER RD
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City | MESA
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State | AZ
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Zip | 85206-5230
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Country | US
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Telephone | 480-985-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 34225 N 27TH DR BLDG 5 STE 241
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City | PHOENIX
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State | AZ
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Zip | 85085
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Country | US
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Telephone | 480-985-1910
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAURA VAUGHN
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Credential |
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Telephone | 623-210-3416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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