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General NPI Number Information
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NPI Number | 1912963125
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Entity Type | Organization
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Legal Business Name | AVONDALE HILLS DENTAL
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11335 W BUCKEYE RD 101C
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 623-478-0149
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Fax | 623-907-5259
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Provider Business Mailing Address
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Address Line | 11335 W BUCKEYE RD 101C
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 623-478-0149
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Fax | 623-907-5259
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Authorized Official
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Title or Position | OWNER
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Name | JASON PAUL ACUFF
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Credential | DDS
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Telephone | 623-478-0149
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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 | 4814
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License Number State | AZ
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