Provider Demographics
NPI:1194935353
Name:CENTERCARE DENTAL GROUP
Entity type:Organization
Organization Name:CENTERCARE DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:STEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-252-2800
Mailing Address - Street 1:340 E PALM LN
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4603
Mailing Address - Country:US
Mailing Address - Phone:602-252-2800
Mailing Address - Fax:602-254-8228
Practice Address - Street 1:340 E PALM LN
Practice Address - Street 2:SUITE 280
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4603
Practice Address - Country:US
Practice Address - Phone:602-252-2800
Practice Address - Fax:602-254-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15761223G0001X
AZ50151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty