Provider Demographics
NPI:1689756819
Name:PLEASANT DENTISTRY PC
Entity Type:Organization
Organization Name:PLEASANT DENTISTRY PC
Other - Org Name:CORPORATION 5
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-878-0120
Mailing Address - Street 1:8279 W LAKE PLEASANT PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-878-0120
Mailing Address - Fax:623-825-6820
Practice Address - Street 1:8279 W LAKE PLEASANT PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-878-0120
Practice Address - Fax:623-825-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty