Provider Demographics
NPI:1689934515
Name:QUALITY DENTAL CARE
Entity Type:Organization
Organization Name:QUALITY DENTAL CARE
Other - Org Name:SHADOW RIDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-214-4898
Mailing Address - Street 1:3970 E RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5412
Mailing Address - Country:US
Mailing Address - Phone:480-214-4898
Mailing Address - Fax:480-214-4902
Practice Address - Street 1:3970 E RIGGS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5412
Practice Address - Country:US
Practice Address - Phone:480-214-4898
Practice Address - Fax:480-214-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty