Provider Demographics
NPI:1568890531
Name:A & Z DENTAL, PC
Entity Type:Organization
Organization Name:A & Z DENTAL, PC
Other - Org Name:ASPEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-464-6000
Mailing Address - Street 1:5550 HIGHWAY 153
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4989
Mailing Address - Country:US
Mailing Address - Phone:423-875-2626
Mailing Address - Fax:423-875-1311
Practice Address - Street 1:281 SANDERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1307
Practice Address - Country:US
Practice Address - Phone:866-273-8204
Practice Address - Fax:866-803-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty