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General NPI Number Information
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NPI Number | 1972925147
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Entity Type | Organization
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Legal Business Name | GENERATION III DENTAL INCORPORATED
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 16080 N 59TH AVE SUITE A
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City | GLENDALE
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State | AZ
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Zip | 85306-2339
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Country | US
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Telephone | 623-398-6808
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Fax | 623-240-0683
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Provider Business Mailing Address
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Address Line | 16080 N 59TH AVE SUITE A
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City | GLENDALE
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State | AZ
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Zip | 85306-2339
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Country | US
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Telephone | 623-398-6808
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Fax | 623-240-0683
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. OKSANA STOJ
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Credential | DMD
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Telephone | 623-398-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D05984
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License Number State | AZ
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