Provider Demographics
NPI:1346322260
Name:PASEO DENTAL PLLC
Entity Type:Organization
Organization Name:PASEO DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OUT
Authorized Official - Middle Name:OF
Authorized Official - Last Name:BUSINESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-978-3878
Mailing Address - Street 1:6120 WEST BELL RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3786
Mailing Address - Country:US
Mailing Address - Phone:602-978-3878
Mailing Address - Fax:602-978-1481
Practice Address - Street 1:6120 WEST BELL RD
Practice Address - Street 2:SUITE 190
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3786
Practice Address - Country:US
Practice Address - Phone:602-978-3878
Practice Address - Fax:602-978-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2607261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental