Organization
DENTAL AND BRACES MARYVALE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZ RAMOS (MANAGER)
(602) 714-8203
Entity
Organization
Contact information
Practice address
6702 W CAMELBACK RD STE 100, GLENDALE, AZ 85303-6324
(602) 635-7450
Mailing address
1515 N GILBERT RD STE 107-131, GILBERT, AZ 85234-2318
(602) 714-8203
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12740016
GENERAL DENTAL OFFICE
—
Enumeration date
02/04/2019
Last updated
02/04/2019
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