Provider Demographics
NPI:1730498320
Name:A2ZPD LLC
Entity Type:Organization
Organization Name:A2ZPD LLC
Other - Org Name:A TO Z PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-503-3764
Mailing Address - Street 1:1810 S CRISMON RD
Mailing Address - Street 2:STE 189
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3717
Mailing Address - Country:US
Mailing Address - Phone:480-503-3764
Mailing Address - Fax:480-380-0336
Practice Address - Street 1:1810 S CRISMON RD
Practice Address - Street 2:STE 189
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3717
Practice Address - Country:US
Practice Address - Phone:480-503-3764
Practice Address - Fax:480-380-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51791223P0221X
AZ77251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ408928Medicaid
AZ558133Medicaid
AZ713546Medicaid