Provider Demographics
NPI:1043902208
Name:POSH DENTAL PEORIA PLLC
Entity Type:Organization
Organization Name:POSH DENTAL PEORIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHYLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-999-6299
Mailing Address - Street 1:21681 N 77TH AVE STE 1420
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2133
Mailing Address - Country:US
Mailing Address - Phone:623-376-7233
Mailing Address - Fax:
Practice Address - Street 1:21681 N 77TH AVE STE 1420
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2133
Practice Address - Country:US
Practice Address - Phone:623-376-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental