Organization
DR. LEONARD BAFALOUKOS D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONARD BAFALOUKOS D.D.S. (OWNER)
(602) 841-5473
Entity
Organization
Contact information
Practice address
3902 W CAMELBACK RD, PHOENIX, AZ 85019-5824
(602) 841-5473
(602) 841-8640
Mailing address
3902 W CAMELBACK RD, PHOENIX, AZ 85019-5824
(602) 841-5473
(602) 841-8640
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1523
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
803093
UNITED CONCORDIA
PA
01
—
AZ0493590
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
06/14/2007
Last updated
08/22/2020
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