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NPI Code Detail

MEDICARE: GP DENTAL PC

MEDICARE: GP DENTAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD6008AZ

General Provider Information

NPI Number : 1710278650
Entity Type Code : Organization
Provider Name (Legal Business Name) : GP DENTAL PC
Provider Business Mailing Address
First Line : 10240 N 31ST AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9564
Country : US
Telephone Number : 602-944-7199
Fax Number :
Provider Business Practice Location Address
First Line : 10240 N 31ST AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9564
Country : US
Telephone Number : 602-944-7199
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : GOLBARG POURKHOMAMI
Credential :
Telephone Number : 602-944-7199
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/26/2011

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Directions to “GP DENTAL PC ” Practice Location

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