Organization
IDENTITY DENTAL SPECIALTIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIYANA PAVLOVA (CEO, PRESIDENT)
(480) 661-4867
Entity
Organization
Contact information
Practice address
18325 N ALLIED WAY STE 115, PHOENIX, AZ 85054-3107
(480) 661-4867
(480) 661-1266
Mailing address
18325 N ALLIED WAY STE 115, PHOENIX, AZ 85054-3107
(480) 661-4867
(480) 661-1266
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2026
Last updated
02/04/2026
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