Provider Demographics
NPI:1306031943
Name:AVON DENTAL PLLC
Entity Type:Organization
Organization Name:AVON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:CHEI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-882-9888
Mailing Address - Street 1:10740 W LOWER BUCKEYE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-9655
Mailing Address - Country:US
Mailing Address - Phone:623-882-9888
Mailing Address - Fax:623-882-9207
Practice Address - Street 1:10740 W LOWER BUCKEYE RD STE 105
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9655
Practice Address - Country:US
Practice Address - Phone:623-882-9888
Practice Address - Fax:623-882-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty