Organization
PHOENIX PEDIATRIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUZ PACHECO (HUMAN RESOURCE)
(602) 242-5741
Entity
Organization
Contact information
Practice address
6750 N 19TH AVE, PHOENIX, AZ 85015-1127
(602) 242-5741
(602) 242-5742
Mailing address
5400 W NORTHERN AVE, GLENDALE, AZ 85301-1406
(602) 242-5741
(602) 242-5742
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D5353
AZ
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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