Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(727) 726-1611
Entity
Organization
Contact information
Practice address
3326 PAPER MILL RD, PHOENIX, MD 21131-1419
(410) 321-8144
Mailing address
3326 PAPER MILL RD, PHOENIX, MD 21131-1419
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MD
Other
Enumeration date
08/01/2014
Last updated
08/01/2014
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