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Organization
FAMILY DENTAL PHOENIX
Active
Organization
FAMILY DENTAL PHOENIX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO QUINTANA (CEO)
(480) 889-9457
Entity
Organization
Contact information
Practice address
2401 W GLENDALE AVE STE 102, PHOENIX, AZ 85021-7621
(602) 864-1119
Mailing address
4435 E HOLMES AVE STE 200, MESA, AZ 85206-3314
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/24/2020
Last updated
05/24/2020
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