Provider Demographics
NPI:1154016467
Name:PWR DENTAL, LLC
Entity type:Organization
Organization Name:PWR DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RDH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LECUYER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:802-922-8486
Mailing Address - Street 1:20071 E ESCALANTE RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9815
Mailing Address - Country:US
Mailing Address - Phone:802-922-8486
Mailing Address - Fax:
Practice Address - Street 1:1545 S POWER RD STE 112
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3736
Practice Address - Country:US
Practice Address - Phone:802-922-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty