Provider Demographics
NPI:1760958359
Name:PM DENTAL
Entity Type:Organization
Organization Name:PM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-568-7880
Mailing Address - Street 1:20800 N JOHN WAYNE PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2728
Mailing Address - Country:US
Mailing Address - Phone:520-568-7880
Mailing Address - Fax:
Practice Address - Street 1:20800 N JOHN WAYNE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2728
Practice Address - Country:US
Practice Address - Phone:520-568-7880
Practice Address - Fax:520-868-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental