Provider Demographics
NPI:1689863748
Name:CROWN DENTAL
Entity Type:Organization
Organization Name:CROWN DENTAL
Other - Org Name:DAZZLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-551-7500
Mailing Address - Street 1:42407 N VISION WAY
Mailing Address - Street 2:101
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1480
Mailing Address - Country:US
Mailing Address - Phone:623-551-7500
Mailing Address - Fax:623-551-2400
Practice Address - Street 1:42407 N VISION WAY
Practice Address - Street 2:101
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-1480
Practice Address - Country:US
Practice Address - Phone:623-551-7500
Practice Address - Fax:623-551-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty