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General NPI Number Information
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NPI Number | 1942402094
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Entity Type | Organization
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Legal Business Name | CONTINENTAL DENTAL CARE 19TH AVE LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 5501 N 19TH AVE SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85015-2450
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Country | US
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Telephone | 602-246-1119
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Fax | 602-249-5080
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Provider Business Mailing Address
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Address Line | 5501 N 19TH AVE SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85015-2450
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Country | US
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Telephone | 602-246-1119
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Fax | 602-249-5080
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Authorized Official
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Title or Position | MEMBER
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Name | HENRY A VASQUEZ
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Credential | RDA
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Telephone | 623-326-8426
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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 | 0213
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License Number State | AZ
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