Provider Demographics
NPI:1679901938
Name:ARCADIA MODERN DENTISTRY, LLP
Entity Type:Organization
Organization Name:ARCADIA MODERN DENTISTRY, LLP
Other - Org Name:ARCADIA MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMATAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-381-2000
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:4310 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5326
Practice Address - Country:US
Practice Address - Phone:602-381-2000
Practice Address - Fax:602-381-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty