Organization
PDA HOLDCO, LLC
Active
Parent organization
PDA HOLDINGS
Other names
Magic Smiles Dental Care, Magic Smiles Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
PDA HOLDINGS
Authorized official
DANIEL MORRISSEY (PRESIDENT)
(602) 253-6600
Entity
Organization
Contact information
Practice address
1457 W SOUTHERN AVE STE 18, MESA, AZ 85202-4853
(480) 610-2300
(480) 833-0682
Mailing address
1701 E THOMAS RD, SUITE #204, PHOENIX, AZ 85016-7646
(602) 253-6600
(602) 279-0821
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D5504
AZ
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
670703
—
AZ
Enumeration date
01/12/2012
Last updated
02/07/2023
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