# THUNDERBIRD DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRIVADENTAL LLC
- **Other names:** AZ Cosmetic & Family Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619449550
- **Legal business name:** BRIVADENTAL LLC
- **Authorized official:** MRS. LETICIA ROJAS (MANAGER)
- **Authorized official phone:** (623) 931-9221

## Contact information

- **Practice address:** 9160 N 43RD AVE, GLENDALE, AZ 85302-3801
- **Practice address phone:** (623) 931-9221
- **Practice address fax:** (623) 937-4315
- **Mailing address:** 9160 N 43RD AVE, GLENDALE, AZ 85302-3801
- **Mailing address phone:** (623) 931-9221
- **Mailing address fax:** (623) 937-4315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/17/2018
- **Last updated:** 09/14/2020