Organization
AZ FAMILY DENTAL - THUNDERBIRD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW PARKER D.M.D (DOCTOR/ OWNER)
(602) 715-6378
Entity
Organization
Contact information
Practice address
1820 W THUNDERBIRD RD STE 2, PHOENIX, AZ 85023-6300
(623) 303-8089
(623) 321-9488
Mailing address
1610 E MCLELLAN RD, MESA, AZ 85203-3944
(623) 303-8089
(623) 321-9488
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336400472
OWNER NPI
AZ
Enumeration date
10/25/2022
Last updated
10/25/2022
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