Organization
AZ SPECIALTY DENTAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (DIRECTOR OF PROVIDERRELATIONS)
(504) 638-0303
Entity
Organization
Contact information
Practice address
2835 E BROWN RD STE 102, MESA, AZ 85213-5470
(615) 678-0759
Mailing address
401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/16/2021
Last updated
07/16/2021
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