Provider Demographics
NPI:1528259009
Name:ARIZONA DENTAL PROFESSIONALS, PC
Entity type:Organization
Organization Name:ARIZONA DENTAL PROFESSIONALS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8312
Mailing Address - Street 1:16605 E PALISADES BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3716
Mailing Address - Country:US
Mailing Address - Phone:480-837-2000
Mailing Address - Fax:480-837-2078
Practice Address - Street 1:16605 E PALISADES BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3716
Practice Address - Country:US
Practice Address - Phone:480-837-2000
Practice Address - Fax:480-837-2078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA DENTAL PROFESSIONALS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty