Provider Demographics
NPI:1124200621
Name:JOHN H. UPTON JR. D.D.S. P.C. MAGD
Entity Type:Organization
Organization Name:JOHN H. UPTON JR. D.D.S. P.C. MAGD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:PC MAGD
Authorized Official - Phone:623-878-6333
Mailing Address - Street 1:18555 N 79TH AVE STE A104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8371
Mailing Address - Country:US
Mailing Address - Phone:623-878-6333
Mailing Address - Fax:
Practice Address - Street 1:18555 N 79TH AVE STE A104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8371
Practice Address - Country:US
Practice Address - Phone:623-878-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty