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General NPI Number Information
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NPI Number | 1932608353
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Entity Type | Organization
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Legal Business Name | VALLEY ORTHODONTIC GROUP/ PEORIA P.L.L.C.
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 25225 N LAKE PLEASANT PKWY STE 1240
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City | PEORIA
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State | AZ
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Zip | 85383-1390
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Country | US
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Telephone | 623-572-2683
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Fax |
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Provider Business Mailing Address
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Address Line | 25225 N LAKE PLEASANT PKWY STE 1240
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City | PEORIA
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State | AZ
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Zip | 85383-1390
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Country | US
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Telephone | 623-572-2683
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DANIEL J GROB
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Credential | DDS, MS
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Telephone | 480-490-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DO3317
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License Number State | AZ
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