Provider Demographics
NPI:1962538579
Name:ASSOCIATED DENTAL CARE PROVIDERS
Entity type:Organization
Organization Name:ASSOCIATED DENTAL CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-290-9702
Mailing Address - Street 1:5620 W THUNDERBIRD RD STE G1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4652
Mailing Address - Country:US
Mailing Address - Phone:602-522-2835
Mailing Address - Fax:602-588-2936
Practice Address - Street 1:5620 W THUNDERBIRD RD STE G1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4652
Practice Address - Country:US
Practice Address - Phone:602-522-2835
Practice Address - Fax:602-588-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty