Provider Demographics
NPI:1275718256
Name:PUSCH RIDGE DENTAL PC
Entity Type:Organization
Organization Name:PUSCH RIDGE DENTAL PC
Other - Org Name:MICHELLE ROMERO CHAVEZ DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMERO CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-742-0830
Mailing Address - Street 1:180 W MAGEE RD STE 158
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5562
Mailing Address - Country:US
Mailing Address - Phone:520-742-0830
Mailing Address - Fax:520-742-3001
Practice Address - Street 1:180 W MAGEE RD STE 158
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-5562
Practice Address - Country:US
Practice Address - Phone:520-742-0830
Practice Address - Fax:520-742-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty