Organization
PHOENIX PEDIATRIC DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUZ PACHECO (BUSINESS MANAGER)
(602) 242-5741
Entity
Organization
Contact information
Practice address
6750 N 19TH AVE, PHOENIX, AZ 85015-1127
(602) 242-5741
(602) 242-5742
Mailing address
6750 N 19TH AVE, PHOENIX, AZ 85015-1127
(602) 242-5741
(602) 242-5742
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409926
—
AZ
05
—
450924
—
AZ
05
—
570475
—
AZ
05
—
627562
—
AZ
05
—
796862
—
AZ
05
—
883737
—
AZ
Enumeration date
10/17/2006
Last updated
12/23/2014
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