Provider Demographics
NPI:1437296852
Name:PERIODONAL SPECIALISTS
Entity Type:Organization
Organization Name:PERIODONAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:480-443-8440
Mailing Address - Street 1:7032 E COCHISE RD
Mailing Address - Street 2:SUITE A220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1490
Mailing Address - Country:US
Mailing Address - Phone:480-443-8440
Mailing Address - Fax:480-443-4767
Practice Address - Street 1:7032 E COCHISE RD
Practice Address - Street 2:SUITE A220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-1490
Practice Address - Country:US
Practice Address - Phone:480-443-8440
Practice Address - Fax:480-443-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty