Provider Demographics
NPI:1376214478
Name:DENTAL HOME CONCEPTS
Entity Type:Organization
Organization Name:DENTAL HOME CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:480-421-8928
Mailing Address - Street 1:36506 N 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0515
Mailing Address - Country:US
Mailing Address - Phone:480-421-8928
Mailing Address - Fax:
Practice Address - Street 1:338 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2402
Practice Address - Country:US
Practice Address - Phone:480-421-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental