Organization
VALLEY PEDIATRIC DENTISTS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL KEITH LOUT DDS MS (PRESIDENT)
(480) 396-3660
Entity
Organization
Contact information
Practice address
6239 E BROWN RD, SUITE #102, MESA, AZ 85205-4933
(480) 396-3660
(480) 396-3697
Mailing address
6239 E BROWN RD, SUITE #102, MESA, AZ 85205-4933
(480) 396-3660
(480) 396-3697
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3911
AZ
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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