Organization
PALI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARISMA LUAT DDS (DENTIST/OWNER)
(623) 937-9241
Entity
Organization
Contact information
Practice address
5511 W GLENDALE AVE, GLENDALE, AZ 85301-2522
(623) 937-9241
Mailing address
5511 W GLENDALE AVE, GLENDALE, AZ 85301-2522
(623) 937-9241
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D008569
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120792
—
AZ
Enumeration date
10/17/2016
Last updated
03/15/2024
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