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General NPI Number Information
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NPI Number | 1922177948
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL VILLAGE, P.C.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7360 S MCCLINTOCK DR
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City | TEMPE
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State | AZ
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Zip | 85283-5001
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Country | US
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Telephone | 480-838-6949
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Fax | 480-838-0092
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Provider Business Mailing Address
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Address Line | 7360 S MCCLINTOCK DR
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City | TEMPE
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State | AZ
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Zip | 85283-5001
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Country | US
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Telephone | 480-838-6949
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Fax | 480-838-0092
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Authorized Official
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Title or Position | COO
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Name | MS. BEVERLY A ADAMS
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Credential |
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Telephone | 480-838-6949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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