Provider Demographics
NPI:1558509869
Name:PRIMERO DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:PRIMERO DENTAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-849-1356
Mailing Address - Street 1:4017 N 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-3728
Mailing Address - Country:US
Mailing Address - Phone:623-873-2500
Mailing Address - Fax:623-849-1356
Practice Address - Street 1:6749 W BETHANY HOME RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4444
Practice Address - Country:US
Practice Address - Phone:623-849-1356
Practice Address - Fax:623-849-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty