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General NPI Number Information
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NPI Number | 1952646788
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Entity Type | Organization
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Legal Business Name | FLEXIBLE DENTAL SOLUTIONS AZ, L.L.C.
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 7500 E ANGUS DR SUITE 1
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6419
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Country | US
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Telephone | 602-363-3166
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Fax | 480-945-0609
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Provider Business Mailing Address
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Address Line | 7500 E ANGUS DR SUITE 1
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6419
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Country | US
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Telephone | 602-363-3166
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Fax | 480-945-0609
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LUIS CERVANTES
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Credential |
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Telephone | 602-363-3166
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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 | AZ2937
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License Number State | AZ
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