# ANTHEM DENTIST

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRIVADENTAL LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407632896
- **Legal business name:** BRIVADENTAL LLC
- **Authorized official:** LETICIA ROJAS (REGIONAL MANAGER)
- **Authorized official phone:** (480) 363-2145

## Contact information

- **Practice address:** 42201 N 41ST DR STE 156, ANTHEM, AZ 85086-3803
- **Practice address phone:** (623) 551-3511
- **Practice address fax:** (623) 551-3513
- **Mailing address:** 42201 N 41ST DR STE 156, ANTHEM, AZ 85086-3803
- **Mailing address phone:** (623) 551-3511
- **Mailing address fax:** (623) 551-3513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2023
- **Last updated:** 09/01/2023