Provider Demographics
NPI:1194890152
Name:ADVANCED DENTAL CONCEPTS PC
Entity type:Organization
Organization Name:ADVANCED DENTAL CONCEPTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-807-9559
Mailing Address - Street 1:801 S POWER ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5222
Mailing Address - Country:US
Mailing Address - Phone:480-807-9559
Mailing Address - Fax:480-807-6876
Practice Address - Street 1:801 S POWER ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5222
Practice Address - Country:US
Practice Address - Phone:480-807-9559
Practice Address - Fax:480-807-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2398AZ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty