# DENTAL AND BRACES ROOSEVELT PLLC

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

## Provider details

- **NPI number:** 1659836369
- **Authorized official:** LIZ RAMOS (MANAGER)
- **Authorized official phone:** (602) 714-8203

## Contact information

- **Practice address:** 1602 E ROOSEVELT ST STE 301, PHOENIX, AZ 85006-3678
- **Practice address phone:** (602) 888-2884
- **Mailing address:** 1515 N GILBERT RD STE 107-131, GILBERT, AZ 85234-2318
- **Mailing address phone:** (602) 714-8203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/06/2019
- **Last updated:** 02/06/2019