Provider Demographics
NPI:1699376616
Name:ARIZONA DENTAL PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:ARIZONA DENTAL PROFESSIONALS, P.C.
Other - Org Name:COTTON RIDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:37591 N GANTZEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7376
Mailing Address - Country:US
Mailing Address - Phone:480-999-3480
Mailing Address - Fax:
Practice Address - Street 1:37591 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7376
Practice Address - Country:US
Practice Address - Phone:480-999-3480
Practice Address - Fax:480-687-7577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA DENTAL PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-05
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty