Organization
AZ DENTAL SPECIALTY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER A BASSETT JR. (OWNER)
(623) 435-2300
Entity
Organization
Contact information
Practice address
9035 N 43RD AVE, STE. C, PHOENIX, AZ 85051
(623) 435-2300
(623) 435-1700
Mailing address
9035 N 43RD AVE, STE. C, PHOENIX, AZ 85051
(623) 435-2300
(623) 435-1700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
F000453
AZ
1223P0300X
Periodontics
8328
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2176
AZ
Other
Enumeration date
10/03/2012
Last updated
10/03/2012
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