Provider Demographics
NPI:1417179870
Name:CHOLLA HILLS FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:CHOLLA HILLS FAMILY DENTISTRY LLC
Other - Org Name:CHOLLA HILLS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIRIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-979-6363
Mailing Address - Street 1:7425 W PEORIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5876
Mailing Address - Country:US
Mailing Address - Phone:623-979-6363
Mailing Address - Fax:623-334-2301
Practice Address - Street 1:7425 W PEORIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5876
Practice Address - Country:US
Practice Address - Phone:623-979-6363
Practice Address - Fax:623-334-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274044OtherDBA
AZ1888390OtherUCCI
AZ76287OtherDHA