Provider Demographics
NPI:1295190072
Name:VENTANA FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:VENTANA FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-566-1200
Mailing Address - Street 1:20403 N LAKE PLEASANT RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9702
Mailing Address - Country:US
Mailing Address - Phone:623-566-1200
Mailing Address - Fax:623-566-0114
Practice Address - Street 1:20403 N LAKE PLEASANT RD
Practice Address - Street 2:SUITE 121
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9702
Practice Address - Country:US
Practice Address - Phone:623-566-1200
Practice Address - Fax:623-566-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty