Provider Demographics
NPI:1598549917
Name:NORTH VALLEY FAMILY DENTIST
Entity type:Organization
Organization Name:NORTH VALLEY FAMILY DENTIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-363-2145
Mailing Address - Street 1:2750 W DOVE VALLEY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5251
Mailing Address - Country:US
Mailing Address - Phone:623-444-6222
Mailing Address - Fax:623-444-7844
Practice Address - Street 1:2750 W DOVE VALLEY RD STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5251
Practice Address - Country:US
Practice Address - Phone:623-444-6222
Practice Address - Fax:623-444-7844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIVADENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty