Provider Demographics
NPI:1437795366
Name:ADAM R DALESANDRO PC
Entity Type:Organization
Organization Name:ADAM R DALESANDRO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:DALESANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-748-8004
Mailing Address - Street 1:762 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4535
Mailing Address - Country:US
Mailing Address - Phone:520-748-8004
Mailing Address - Fax:520-327-0907
Practice Address - Street 1:762 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4535
Practice Address - Country:US
Practice Address - Phone:520-748-8004
Practice Address - Fax:520-327-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty