# PRESCOTT VALLEY ENDODONTIC ASSOCIATES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRESCOTT ENDODONTIC ASSOCIATES PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639783749
- **Legal business name:** PRESCOTT ENDODONTIC ASSOCIATES PC
- **Authorized official:** JORDAN OHLSON (MANAGER)
- **Authorized official phone:** (928) 771-1640

## Contact information

- **Practice address:** 8053 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-9423
- **Practice address phone:** (928) 771-1640
- **Practice address fax:** (928) 771-1640
- **Mailing address:** 1658 OAKLAWN DR, PRESCOTT, AZ 86305-1110
- **Mailing address phone:** (928) 771-1640
- **Mailing address fax:** (928) 771-1640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 09/04/2020
- **Last updated:** 09/04/2020