Provider Demographics
NPI:1083724579
Name:DENTAL ONW
Entity Type:Organization
Organization Name:DENTAL ONW
Other - Org Name:WEST VALLEY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-376-9400
Mailing Address - Street 1:20359 N 59TH AVE
Mailing Address - Street 2:#101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-376-9400
Mailing Address - Fax:623-376-7765
Practice Address - Street 1:20359 N 59TH AVE
Practice Address - Street 2:#101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-376-9400
Practice Address - Fax:623-376-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3303122300000X
AZ6691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty