Provider Demographics
NPI:1598337255
Name:ADMINISURG LLC
Entity Type:Organization
Organization Name:ADMINISURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERUEL CASTELLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-945-3629
Mailing Address - Street 1:PO BOX 29650 880338
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:480-945-3629
Mailing Address - Fax:480-664-8972
Practice Address - Street 1:1489 S HIGLEY RD BLDG 1
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4776
Practice Address - Country:US
Practice Address - Phone:480-945-3629
Practice Address - Fax:480-664-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty