Provider Demographics
NPI:1528605649
Name:DENTISTS AT QUEEN CREEK, PLLC
Entity Type:Organization
Organization Name:DENTISTS AT QUEEN CREEK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-869-4535
Mailing Address - Street 1:1046 WESTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-4629
Mailing Address - Country:US
Mailing Address - Phone:315-761-9837
Mailing Address - Fax:
Practice Address - Street 1:21295 S ELLSWORTH LOOP RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9866
Practice Address - Country:US
Practice Address - Phone:480-445-9188
Practice Address - Fax:480-526-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty