Provider Demographics
NPI:1063186864
Name:DELICATE DENTAL GROUP LLC
Entity type:Organization
Organization Name:DELICATE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:917-660-0421
Mailing Address - Street 1:1855 W GREENWAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3475
Mailing Address - Country:US
Mailing Address - Phone:602-805-1110
Mailing Address - Fax:602-805-1112
Practice Address - Street 1:1855 W GREENWAY RD STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3475
Practice Address - Country:US
Practice Address - Phone:602-805-1110
Practice Address - Fax:602-805-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty