Organization
94TH DRIVE, LLC
Active
Other names
Peoria Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MISS FAWNE E PRYOR MGR (INSURANCE MANAGER)
(623) 582-3902
Entity
Organization
Contact information
Practice address
13660 N 94TH DR, B-1, PEORIA, AZ 85381-4836
(623) 977-2551
(623) 977-9515
Mailing address
13660 N 94TH DR, B-1, PEORIA, AZ 85381-4836
(623) 977-2551
(623) 977-9515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6772
AZ
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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