Provider Demographics
NPI:1467179325
Name:IT'S YOUR TIME DENTAL
Entity Type:Organization
Organization Name:IT'S YOUR TIME DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:PARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-966-5335
Mailing Address - Street 1:22450 S 201ST CT
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6311
Mailing Address - Country:US
Mailing Address - Phone:530-966-2011
Mailing Address - Fax:
Practice Address - Street 1:21295 S ELLSWORTH LOOP RD STE 103
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9867
Practice Address - Country:US
Practice Address - Phone:480-571-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty