Provider Demographics
NPI:1790063295
Name:IDS DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:IDS DENTAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-740-7465
Mailing Address - Street 1:8046 N 2ND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5607
Mailing Address - Country:US
Mailing Address - Phone:602-639-0688
Mailing Address - Fax:
Practice Address - Street 1:2620 S 83RD AVE
Practice Address - Street 2:STE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7203
Practice Address - Country:US
Practice Address - Phone:623-936-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty