Provider Demographics
NPI:1134694698
Name:DENTISTS OF PHOENIX, LLP
Entity Type:Organization
Organization Name:DENTISTS OF PHOENIX, LLP
Other - Org Name:THE KIDS DENTAL OFFICE OF PHOENIX AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIMMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-903-4849
Mailing Address - Street 1:1934 E CAMELBACK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4126
Mailing Address - Country:US
Mailing Address - Phone:602-903-4894
Mailing Address - Fax:602-675-9843
Practice Address - Street 1:1934 E CAMELBACK RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4126
Practice Address - Country:US
Practice Address - Phone:602-903-4894
Practice Address - Fax:602-675-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty