Provider Demographics
NPI:1558586420
Name:WEST VALLEY ORTHODONTICS, PC
Entity Type:Organization
Organization Name:WEST VALLEY ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:623-935-7288
Mailing Address - Street 1:13575 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4901
Mailing Address - Country:US
Mailing Address - Phone:623-935-7288
Mailing Address - Fax:
Practice Address - Street 1:13575 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 900
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4901
Practice Address - Country:US
Practice Address - Phone:623-935-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD55161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty