Provider Demographics
NPI:1235278680
Name:DYNAMIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:DYNAMIC DENTISTRY, PLLC
Other - Org Name:MCINNES FAMILY DENTISTRY, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINNES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-961-4888
Mailing Address - Street 1:5355 W CHANDLER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-8603
Mailing Address - Country:US
Mailing Address - Phone:480-961-4888
Mailing Address - Fax:
Practice Address - Street 1:5355 W CHANDLER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-8603
Practice Address - Country:US
Practice Address - Phone:480-961-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty