Provider Demographics
NPI:1770181042
Name:DENTAL AND BRACES LAVEEN
Entity Type:Organization
Organization Name:DENTAL AND BRACES LAVEEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-726-3221
Mailing Address - Street 1:1515 N GILBERT RD STE 107-131
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2318
Mailing Address - Country:US
Mailing Address - Phone:602-726-3221
Mailing Address - Fax:602-714-8203
Practice Address - Street 1:3624 W BASELINE RD STE 170
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3044
Practice Address - Country:US
Practice Address - Phone:602-935-6202
Practice Address - Fax:602-714-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental