Provider Demographics
NPI:1114240942
Name:NEW CONCEPT DENTAL
Entity type:Organization
Organization Name:NEW CONCEPT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-925-1399
Mailing Address - Street 1:725 N CENTRAL AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1659
Mailing Address - Country:US
Mailing Address - Phone:623-925-1399
Mailing Address - Fax:623-882-8083
Practice Address - Street 1:725 N CENTRAL AVE STE 109
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1659
Practice Address - Country:US
Practice Address - Phone:623-925-1399
Practice Address - Fax:623-882-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ90279261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental