Organization
NBA DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAWNE E PRYOR (INS MGR)
(623) 536-2040
Entity
Organization
Contact information
Practice address
4102 N 24TH ST, B-2, PHOENIX, AZ 85016-6283
(602) 956-2024
(602) 956-2209
Mailing address
4102 N 24TH ST, B-2, PHOENIX, AZ 85016-6283
(602) 956-2024
(602) 956-2209
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5981
AZ
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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