Provider Demographics
NPI:1003691312
Name:DENTOPRO, LLC
Entity Type:Organization
Organization Name:DENTOPRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-512-8328
Mailing Address - Street 1:635 E PIPING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4215
Mailing Address - Country:US
Mailing Address - Phone:626-512-8328
Mailing Address - Fax:
Practice Address - Street 1:5940 W UNION HILLS DR STE F110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1304
Practice Address - Country:US
Practice Address - Phone:602-863-7692
Practice Address - Fax:602-863-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental