Provider Demographics
NPI:1073156709
Name:MARTIN DENTAL-AIRPARK LLC
Entity Type:Organization
Organization Name:MARTIN DENTAL-AIRPARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-498-4191
Mailing Address - Street 1:20556 E PECAN LN STE 130
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-0504
Mailing Address - Country:US
Mailing Address - Phone:480-498-4191
Mailing Address - Fax:480-586-7160
Practice Address - Street 1:1775 E QUEEN CREEK RD STE 130
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2012
Practice Address - Country:US
Practice Address - Phone:480-498-4191
Practice Address - Fax:480-586-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty