# ATD4 LLC

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

## Provider details

- **NPI number:** 1619814605
- **Authorized official:** LILLIE BOWERS (MANAGER)
- **Authorized official phone:** (480) 914-2655

## Contact information

- **Practice address:** 35979 N GARY RD STE 104, SAN TAN VALLEY, AZ 85143-5750
- **Practice address phone:** (480) 914-2655
- **Mailing address:** 35979 N GARY RD STE 104, SAN TAN VALLEY, AZ 85143-5750
- **Mailing address phone:** (480) 914-2655

## Taxonomy

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

## Other

- **Enumeration date:** 04/29/2026
- **Last updated:** 04/29/2026