Provider Demographics
NPI:1427077619
Name:VICTOR COSMETIC AND FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:VICTOR COSMETIC AND FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-933-8500
Mailing Address - Street 1:8663 W UNION HILLS DR
Mailing Address - Street 2:SUTE #400
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7004
Mailing Address - Country:US
Mailing Address - Phone:623-933-8500
Mailing Address - Fax:623-933-8501
Practice Address - Street 1:8663 W UNION HILLS DR
Practice Address - Street 2:SUTE #400
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7004
Practice Address - Country:US
Practice Address - Phone:623-933-8500
Practice Address - Fax:623-933-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty