Provider Demographics
NPI:1043754393
Name:EMBRACE ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:EMBRACE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUZANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-931-4386
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE B230
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE B230
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-931-4386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty