Provider Demographics
NPI:1477833069
Name:DA VINCI DENTAL PHOENIX
Entity Type:Organization
Organization Name:DA VINCI DENTAL PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-336-1111
Mailing Address - Street 1:5336 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1903
Mailing Address - Country:US
Mailing Address - Phone:602-336-1111
Mailing Address - Fax:
Practice Address - Street 1:5336 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1903
Practice Address - Country:US
Practice Address - Phone:602-336-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty