Provider Demographics
NPI:1225352289
Name:CROFT ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:CROFT ORTHODONTICS PLLC
Other - Org Name:VISTANCIA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:623-566-0800
Mailing Address - Street 1:9772 W YEARLING RD STE A1600
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1380
Mailing Address - Country:US
Mailing Address - Phone:623-566-0800
Mailing Address - Fax:623-566-0860
Practice Address - Street 1:9772 W YEARLING RD
Practice Address - Street 2:STE A1600
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1380
Practice Address - Country:US
Practice Address - Phone:623-566-0800
Practice Address - Fax:833-330-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76161223X0400X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ162964Medicaid
AZ518939Medicaid