Provider Demographics
NPI:1003526401
Name:DISPATCH DENTAL LLC
Entity Type:Organization
Organization Name:DISPATCH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-209-2525
Mailing Address - Street 1:9759 E LOBO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2551
Mailing Address - Country:US
Mailing Address - Phone:480-209-2525
Mailing Address - Fax:
Practice Address - Street 1:1403 W 10TH PL STE B104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5256
Practice Address - Country:US
Practice Address - Phone:623-584-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty