Organization
EL MIRAGE DENTISTRY
Active
Other names
Classical Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
FAWNE E PRYOR (INS MGR)
(623) 582-3909
Entity
Organization
Contact information
Practice address
10111 N EL MIRAGE RD, EL MIRAGE, AZ 85335-3605
(623) 582-3909
(623) 582-3902
Mailing address
10111 N EL MIRAGE RD, EL MIRAGE, AZ 85335-3605
(623) 582-3909
(623) 582-3902
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7345
AZ
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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