Organization
EMPIRE DENTAL ESTHETICS OF ARIZONA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYASANKER VALIYAPARAMBIL DDS (OWNER/DENTIST)
(623) 594-2057
Entity
Organization
Contact information
Practice address
7170 W CAMINO SAN XAVIER STE A101, GLENDALE, AZ 85308-0834
(623) 594-2057
Mailing address
7170 W CAMINO SAN XAVIER STE A101, GLENDALE, AZ 85308-0834
(623) 594-2057
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
292200000X
Dental Laboratory
—
—
Other
Enumeration date
02/14/2022
Last updated
02/14/2022
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