Provider Demographics
NPI:1003998238
Name:POSPISIL DENTISTRY OF GILBERT
Entity Type:Organization
Organization Name:POSPISIL DENTISTRY OF GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:POSPISIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-838-3305
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:STE. 106
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6675
Mailing Address - Country:US
Mailing Address - Phone:480-838-3305
Mailing Address - Fax:480-838-3670
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:STE. 106
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6675
Practice Address - Country:US
Practice Address - Phone:480-838-3305
Practice Address - Fax:480-838-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER