Organization
AZ LIFETIME DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA MICHELLE ELROD D.D.S. (DENTIST/OWNER)
(480) 544-2240
Entity
Organization
Contact information
Practice address
13065 W MCDOWELL RD STE 112, AVONDALE, AZ 85392-6439
(623) 455-6958
Mailing address
11445 E VIA LINDA STE 2422, SCOTTSDALE, AZ 85259-2655
(480) 544-2240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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