Organization
COMMUNITY DENTAL PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EOIN KIRBY (CREDENTIALING SUPERVISOR)
(602) 370-1511
Entity
Organization
Contact information
Practice address
21321 E OCOTILLO RD, BLDG C STE.106, QUEEN CREEK, AZ 85142-5996
(602) 370-1511
(602) 265-4007
Mailing address
3221 N 24TH ST, STE. 23, PHOENIX, AZ 85016-7358
(602) 370-1511
(602) 265-4007
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5063
AZ
1223P0221X
Pediatric Dentistry
D5110
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D1819
AZ
Other
Enumeration date
02/14/2012
Last updated
02/29/2012
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