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Organization

SCOTTSDALE IMPLANT AND COSMETIC DENTISTRY LLC

Active
Parent organization
VALLEY IMPLANT CENTERS PLLC
Other names
Scottsdale Implant and Cosmetic Dentistry
Organization subpart
Yes

Provider details

NPI number
Legal business name
VALLEY IMPLANT CENTERS PLLC
Authorized official
MRS. PORTIA L FREDSTRUP (OWNER)
(602) 303-5827
Entity
Organization

Contact information

Practice address
4910 E GREENWAY RD STE 7, SCOTTSDALE, AZ 85254-1653
(480) 200-3453
Mailing address
7547 S FRONTIER ST, GILBERT, AZ 85298-0130

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D009808
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1457874901
PROVIDER NPI
AZ
Enumeration date
04/13/2018
Last updated
06/16/2018
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