Provider Demographics
NPI:1164895306
Name:A G CORP INC
Entity Type:Organization
Organization Name:A G CORP INC
Other - Org Name:DENTISTRY AT GREENWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAROLL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:623-582-9622
Mailing Address - Street 1:16630 W GREENWAY RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-2185
Mailing Address - Country:US
Mailing Address - Phone:623-582-9622
Mailing Address - Fax:623-537-5430
Practice Address - Street 1:16630 W GREENWAY RD
Practice Address - Street 2:SUITE 319
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2185
Practice Address - Country:US
Practice Address - Phone:623-582-9622
Practice Address - Fax:623-537-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0089621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty