Provider Demographics
NPI:1003458688
Name:UPTOWN PEDIATRIC DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:UPTOWN PEDIATRIC DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:NEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-234-5526
Mailing Address - Street 1:7236 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5236
Mailing Address - Country:US
Mailing Address - Phone:312-345-5526
Mailing Address - Fax:
Practice Address - Street 1:1515 E MISSOURI AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2443
Practice Address - Country:US
Practice Address - Phone:602-279-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental