Provider Demographics
NPI:1326349523
Name:A.T. STILL UNIVERSITY OF HEALTH SCIENCES
Entity Type:Organization
Organization Name:A.T. STILL UNIVERSITY OF HEALTH SCIENCES
Other - Org Name:ARIZONA SCHOOL OF DENTISTRY & ORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-219-6181
Mailing Address - Street 1:5855 E STILL CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3631
Mailing Address - Country:US
Mailing Address - Phone:480-248-8100
Mailing Address - Fax:480-248-8181
Practice Address - Street 1:5855 E STILL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3631
Practice Address - Country:US
Practice Address - Phone:480-248-8100
Practice Address - Fax:480-248-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD44451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty