Provider Demographics
NPI:1710319371
Name:GBH DENTAL LLC
Entity Type:Organization
Organization Name:GBH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-363-3322
Mailing Address - Street 1:1628 E SOUTHERN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5685
Mailing Address - Country:US
Mailing Address - Phone:480-831-3898
Mailing Address - Fax:480-831-9352
Practice Address - Street 1:1628 E SOUTHERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5685
Practice Address - Country:US
Practice Address - Phone:480-831-3898
Practice Address - Fax:480-831-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental