Provider Demographics
NPI:1104395094
Name:SIGNATURE ARIZONA DENTAL PARTNERS LLC
Entity Type:Organization
Organization Name:SIGNATURE ARIZONA DENTAL PARTNERS LLC
Other - Org Name:FAMILY DENTISTRY OF BUCKEYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INTEGRATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-8490
Mailing Address - Street 1:410 N 44TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7622
Mailing Address - Country:US
Mailing Address - Phone:480-626-4154
Mailing Address - Fax:
Practice Address - Street 1:2525 S RURAL RD STE 2S
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2400
Practice Address - Country:US
Practice Address - Phone:480-967-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-20
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental