Organization
ABC PEDIATRIC DENTAL PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN MENLOVE DDS (PRESIDENT)
(801) 448-2346
Entity
Organization
Contact information
Practice address
16222 W BOCA RATON RD, SURPRISE, AZ 85379-5073
(801) 448-2346
Mailing address
4444 W THOMAS RD, PHOENIX, AZ 85031-3728
(801) 448-2346
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6361
AZ
Other
Enumeration date
03/27/2014
Last updated
03/27/2014
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