Organization
DENTAL AND BRACES ROOSEVELT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZ RAMOS (MANAGER)
(602) 714-8203
Entity
Organization
Contact information
Practice address
1602 E ROOSEVELT ST STE 301, PHOENIX, AZ 85006-3678
(602) 888-2884
Mailing address
1515 N GILBERT RD STE 107-131, GILBERT, AZ 85234-2318
(602) 714-8203
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11901383
DENTAL OFFICE
AZ
Enumeration date
02/06/2019
Last updated
02/06/2019
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