Provider Demographics
NPI:1063970317
Name:METTLER GRIEGO FAMILY DENTISTRY PLCC
Entity type:Organization
Organization Name:METTLER GRIEGO FAMILY DENTISTRY PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-487-4870
Mailing Address - Street 1:7505 W DEER VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2107
Mailing Address - Country:US
Mailing Address - Phone:623-487-4870
Mailing Address - Fax:623-979-8737
Practice Address - Street 1:7505 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2107
Practice Address - Country:US
Practice Address - Phone:623-487-4870
Practice Address - Fax:623-979-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty