Organization
PRESCOTT VALLEY ENDODONTIC ASSOCIATES, PLLC
Active
Parent organization
PRESCOTT ENDODONTIC ASSOCIATES PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRESCOTT ENDODONTIC ASSOCIATES PC
Authorized official
JORDAN OHLSON (MANAGER)
(928) 771-1640
Entity
Organization
Contact information
Practice address
8053 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-9423
(928) 771-1640
(928) 771-1640
Mailing address
1658 OAKLAWN DR, PRESCOTT, AZ 86305-1110
(928) 771-1640
(928) 771-1640
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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