Provider Demographics
NPI:1427226307
Name:DENTURE SPECIALIST
Entity Type:Organization
Organization Name:DENTURE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-651-1436
Mailing Address - Street 1:2525 W GREENWAY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4226
Mailing Address - Country:US
Mailing Address - Phone:602-651-1436
Mailing Address - Fax:602-680-7364
Practice Address - Street 1:2525 W GREENWAY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023
Practice Address - Country:US
Practice Address - Phone:602-651-1436
Practice Address - Fax:602-680-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental