Organization
PDA HOLDINGS, LLC
Active
Other names
Magic Smiles Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA J TRUJILLO (CREDENTIALING MANAGER)
(602) 253-6600
Entity
Organization
Contact information
Practice address
1701 E THOMAS RD #204, PHOENIX, AZ 85016
(602) 253-6600
(602) 279-0821
Mailing address
1701 E THOMAS RD STE 204, PHOENIX, AZ 85016-7675
(602) 253-6600
(602) 279-0821
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232643
AHCCCS PROVIDER ID
AZ
Enumeration date
04/18/2007
Last updated
02/07/2023
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