Organization
ADVANCED DENTAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER SPILOTRO D.D.S. (OWNER/PRESIDENT)
(623) 680-9911
Entity
Organization
Contact information
Practice address
15440 N 7TH ST, SUITE 8, PHOENIX, AZ 85022-3535
(602) 504-6400
(602) 504-6300
Mailing address
7217 W CAMINO DE ORO, PEORIA, AZ 85383-3266
(602) 504-6400
(602) 504-6300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D4664
AZ
122300000X
Dentist
Primary
D5123
AZ
1223E0200X
Endodontics
D5915
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
633679
—
AZ
05
—
639651
—
AZ
05
—
835324
—
AZ
01
—
996431
UNITED CONCORDIA
AZ
01
—
AZ0414080
BLUE CROSS BLUE SHIELD OF AZ
AZ
Enumeration date
06/28/2012
Last updated
06/28/2012
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