Provider Demographics
NPI:1710011374
Name:FLAGSTAFF PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:FLAGSTAFF PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-774-1219
Mailing Address - Street 1:906 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2986
Mailing Address - Country:US
Mailing Address - Phone:928-774-1219
Mailing Address - Fax:
Practice Address - Street 1:906 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2986
Practice Address - Country:US
Practice Address - Phone:928-774-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty