Provider Demographics
NPI:1609989748
Name:A PAUL SERRANO DDS PC
Entity Type:Organization
Organization Name:A PAUL SERRANO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-274-7840
Mailing Address - Street 1:1515 E MISSOURI
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2443
Mailing Address - Country:US
Mailing Address - Phone:602-274-7840
Mailing Address - Fax:602-274-7956
Practice Address - Street 1:1515 E MISSOURI
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2443
Practice Address - Country:US
Practice Address - Phone:602-274-7840
Practice Address - Fax:602-274-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD28141223X0400X
AZD55431223X0400X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6392840001Medicare NSC