Provider Demographics
NPI:1508927401
Name:DUNCAN, PASTORA (DDS)
Entity Type:Individual
Prefix:
First Name:PASTORA
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 W NORTHERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1539
Mailing Address - Country:US
Mailing Address - Phone:623-931-7451
Mailing Address - Fax:623-937-2367
Practice Address - Street 1:5041 W NORTHERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1539
Practice Address - Country:US
Practice Address - Phone:623-931-7451
Practice Address - Fax:623-937-2367
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice