Provider Demographics
NPI:1316181910
Name:WHOLESALE DENTISTRY GROUP LLC
Entity Type:Organization
Organization Name:WHOLESALE DENTISTRY GROUP LLC
Other - Org Name:UNION HILLS FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAROLL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-225-6555
Mailing Address - Street 1:23525 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310
Mailing Address - Country:US
Mailing Address - Phone:623-434-0620
Mailing Address - Fax:623-572-7642
Practice Address - Street 1:3414 W UNION HILLS DR.
Practice Address - Street 2:SUITE 14
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-434-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty