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General NPI Number Information
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NPI Number | 1932694817
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Entity Type | Organization
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Legal Business Name | VALUE DENTAL DMSO LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2750 E GERMANN RD
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City | CHANDLER
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State | AZ
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Zip | 85286-1403
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Country | US
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Telephone | 480-626-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 1628 E SOUTHERN AVE STE 9-232
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City | TEMPE
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State | AZ
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Zip | 85282-5782
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Country | US
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Telephone | 702-449-0881
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SEVERN BIZZARO
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Credential |
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Telephone | 702-449-0881
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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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