Provider Demographics
NPI:1699739987
Name:ARIZONA HEIGHTS DENTISTRY@ANTHEM PC
Entity type:Organization
Organization Name:ARIZONA HEIGHTS DENTISTRY@ANTHEM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHUN
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-551-3511
Mailing Address - Street 1:42201 N 41 DR
Mailing Address - Street 2:STE 156
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-3511
Mailing Address - Fax:623-551-3513
Practice Address - Street 1:42201 N 41 DR
Practice Address - Street 2:STE 156
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-3511
Practice Address - Fax:623-551-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD46611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty