# ANTHEM DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Classical Dentistry of Arizona
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861658304
- **Authorized official:** MRS. FAWNE E PRYOR (INSURANCE MANAGER)
- **Authorized official phone:** (480) 619-7023

## Contact information

- **Practice address:** 41111 N DAISY MOUNTAIN DR, SUITE 105, ANTHEM, AZ 85086-4957
- **Practice address phone:** (623) 551-5444
- **Practice address fax:** (623) 551-2522
- **Mailing address:** 41111 N DAISY MOUNTAIN DR, SUITE 105, ANTHEM, AZ 85086-4957
- **Mailing address phone:** (623) 551-5444
- **Mailing address fax:** (623) 551-2522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5002 | AZ | Yes |

## Other

- **Enumeration date:** 08/04/2008
- **Last updated:** 08/04/2008