Organization
IMAGINE DENTAL
Active
Parent organization
DENTAL SPECIALTY ASSOCIATES
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SPECIALTY ASSOCIATES
Authorized official
DR. BRIAN LILIEN DDS (OWNER)
(480) 633-9977
Entity
Organization
Contact information
Practice address
650 W MARYLAND AVE, 1-2, PHOENIX, AZ 85013-1399
(480) 633-9977
Mailing address
650 W MARYLAND AVE, 1-2, PHOENIX, AZ 85013-1399
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D07028
AZ
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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