Provider Demographics
NPI:1447406228
Name:ARIZONA CENTER FOR IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:ARIZONA CENTER FOR IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-491-1313
Mailing Address - Street 1:2103 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7503
Mailing Address - Country:US
Mailing Address - Phone:480-491-1313
Mailing Address - Fax:480-491-1926
Practice Address - Street 1:2103 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7503
Practice Address - Country:US
Practice Address - Phone:480-491-1313
Practice Address - Fax:480-491-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty