Provider Demographics
NPI:1568258465
Name:ENDEAVOR DENTAL AZ LLC
Entity type:Organization
Organization Name:ENDEAVOR DENTAL AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-671-7956
Mailing Address - Street 1:618 N HAYSTACK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-5637
Mailing Address - Country:US
Mailing Address - Phone:435-671-7956
Mailing Address - Fax:
Practice Address - Street 1:111 W MONROE ST STE 131
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1717
Practice Address - Country:US
Practice Address - Phone:435-671-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental