Provider Demographics
NPI:1194213744
Name:ARIZONA DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:ARIZONA DENTAL PARTNERS PLLC
Other - Org Name:DOBRA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA-MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-989-8149
Mailing Address - Street 1:17235 N 75TH AVE STE C135
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17235 N 75TH AVE STE C135
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0880
Practice Address - Country:US
Practice Address - Phone:480-415-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA DENTAL PARTNERS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008961261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental