Provider Demographics
NPI:1477708774
Name:PLEASANT VALLEY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PLEASANT VALLEY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-561-1470
Mailing Address - Street 1:9784 W YEARLING RD
Mailing Address - Street 2:#1500
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1379
Mailing Address - Country:US
Mailing Address - Phone:623-561-1470
Mailing Address - Fax:623-561-1169
Practice Address - Street 1:9784 W YEARLING RD
Practice Address - Street 2:#1500
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1379
Practice Address - Country:US
Practice Address - Phone:623-561-1470
Practice Address - Fax:623-561-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty