Provider Demographics
NPI:1598035214
Name:PLEASANT DENTAL PARTNERS PC
Entity Type:Organization
Organization Name:PLEASANT DENTAL PARTNERS PC
Other - Org Name:NICE NICE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-825-0616
Mailing Address - Street 1:9772 W YEARLING RD STE A1680
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1380
Mailing Address - Country:US
Mailing Address - Phone:623-825-0616
Mailing Address - Fax:623-825-0786
Practice Address - Street 1:9772 W YEARLING RD STE A1680
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1380
Practice Address - Country:US
Practice Address - Phone:623-825-0616
Practice Address - Fax:623-825-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1245265032OtherINDIVIDUAL NPI NUMBER