Provider Demographics
NPI:1467929448
Name:GANTZEL DENTAL CENTER
Entity Type:Organization
Organization Name:GANTZEL DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-818-3177
Mailing Address - Street 1:36327 N GANTZEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7328
Mailing Address - Country:US
Mailing Address - Phone:480-818-3177
Mailing Address - Fax:
Practice Address - Street 1:36327 N GANTZEL RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7328
Practice Address - Country:US
Practice Address - Phone:480-818-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental