# COMMUNITY DENTAL PARTNERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386917839
- **Authorized official:** MR. EOIN KIRBY (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (602) 370-1511

## Contact information

- **Practice address:** 21321 E OCOTILLO RD, BLDG C STE.106, QUEEN CREEK, AZ 85142-5996
- **Practice address phone:** (602) 370-1511
- **Practice address fax:** (602) 265-4007
- **Mailing address:** 3221 N 24TH ST, STE. 23, PHOENIX, AZ 85016-7358
- **Mailing address phone:** (602) 370-1511
- **Mailing address fax:** (602) 265-4007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5063 | AZ | Yes |
| 1223P0221X | Pediatric Dentistry | D5110 | AZ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D1819 | AZ | — |

## Other

- **Enumeration date:** 02/14/2012
- **Last updated:** 02/29/2012