Organization
DENTAL AND BRACES LAVEEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH RAMOS (CREDENTIALING)
(602) 726-3221
Entity
Organization
Contact information
Practice address
3624 W BASELINE RD STE 170, LAVEEN, AZ 85339-3044
(602) 935-6202
(602) 714-8203
Mailing address
1515 N GILBERT RD STE 107-131, GILBERT, AZ 85234-2318
(602) 726-3221
(602) 714-8203
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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