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Organization
ANTHEM DENTIST
Active
Organization
ANTHEM DENTIST
Active
Parent organization
BRIVADENTAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRIVADENTAL LLC
Authorized official
LETICIA ROJAS (REGIONAL MANAGER)
(480) 363-2145
Entity
Organization
Contact information
Practice address
42201 N 41ST DR STE 156, ANTHEM, AZ 85086-3803
(623) 551-3511
(623) 551-3513
Mailing address
42201 N 41ST DR STE 156, ANTHEM, AZ 85086-3803
(623) 551-3511
(623) 551-3513
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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