Provider Demographics
NPI:1609238328
Name:ONCALL DENTAL URGENT CARE LLC
Entity Type:Organization
Organization Name:ONCALL DENTAL URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-355-4131
Mailing Address - Street 1:3244 S MILL AVE
Mailing Address - Street 2:105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-355-4131
Mailing Address - Fax:
Practice Address - Street 1:3244 S MILL AVE
Practice Address - Street 2:105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3667
Practice Address - Country:US
Practice Address - Phone:480-355-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty