Provider Demographics
NPI:1225692213
Name:ROBERTS & GARZA ORTHODONTICS SERVICES PLLC
Entity Type:Organization
Organization Name:ROBERTS & GARZA ORTHODONTICS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:232-829-9596
Mailing Address - Street 1:7170 W CAMINO SAN XAVIER STE C109
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0862
Mailing Address - Country:US
Mailing Address - Phone:623-282-9950
Mailing Address - Fax:
Practice Address - Street 1:946 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-8825
Practice Address - Country:US
Practice Address - Phone:662-996-2816
Practice Address - Fax:662-985-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty