Provider Demographics
NPI:1457478299
Name:AAA DENTAL CARE PC
Entity Type:Organization
Organization Name:AAA DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-242-5406
Mailing Address - Street 1:4837 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3011
Mailing Address - Country:US
Mailing Address - Phone:602-242-5406
Mailing Address - Fax:602-242-5407
Practice Address - Street 1:4837 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3011
Practice Address - Country:US
Practice Address - Phone:602-242-5406
Practice Address - Fax:602-242-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480468Medicaid