Provider Demographics
NPI:1124578919
Name:PHOENICIAN DENTAL CENTER LLC
Entity Type:Organization
Organization Name:PHOENICIAN DENTAL CENTER LLC
Other - Org Name:PHOENICIAN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANUPAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-7447
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5941
Mailing Address - Country:US
Mailing Address - Phone:480-963-2797
Mailing Address - Fax:480-407-7633
Practice Address - Street 1:1343 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5941
Practice Address - Country:US
Practice Address - Phone:480-963-2797
Practice Address - Fax:480-407-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL20648437OtherARIZONA CORPORATION COMISSION FILE NUMBER