Organization
PEDIATRIC DENTAL SPECIALISTS, PPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN LEE STAKER DDS (TREASURER)
(480) 558-0777
Entity
Organization
Contact information
Practice address
2550 E GUADALUPE RD, SUITE 101, GILBERT, AZ 85234-5114
(480) 558-0777
(480) 558-0888
Mailing address
2550 E GUADALUPE RD, SUITE 101, GILBERT, AZ 85234-5114
(480) 558-0777
(480) 558-0888
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
AZ
Other
Enumeration date
06/30/2005
Last updated
07/21/2022
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