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NPI Code Detail

MEDICARE: VALUE DENTAL DMSO LLC

MEDICARE: VALUE DENTAL DMSO LLC
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
1261QD0000XDental Clinic/Center

General Provider Information

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

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Directions to “VALUE DENTAL DMSO LLC ” Practice Location

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