Organization
PASEO RANCH PEDIATRIC DENTISTRY AND ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATHEW JENSEN DMD (DENTIST AND OWNER)
(623) 606-2217
Entity
Organization
Contact information
Practice address
6677 W THUNDERBIRD RD STE A124, GLENDALE, AZ 85306-3710
(623) 223-9677
Mailing address
6677 W THUNDERBIRD RD STE A124, GLENDALE, AZ 85306-3710
(623) 223-9677
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200173
—
AZ
Enumeration date
04/17/2020
Last updated
04/17/2020
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