Provider Demographics
NPI:1194851790
Name:ASSOCIATED DENTAL CARE PROVIDERS
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL CARE PROVIDERS
Other - Org Name:ASSOCIATED DENTAL CARE SCOTTSDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:7425 E SHEA BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6411
Mailing Address - Country:US
Mailing Address - Phone:480-443-1717
Mailing Address - Fax:480-443-1818
Practice Address - Street 1:7425 E SHEA BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-443-1717
Practice Address - Fax:480-443-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty