Provider Demographics
NPI:1821549718
Name:ADVALOR PLC
Entity Type:Organization
Organization Name:ADVALOR PLC
Other - Org Name:GARY D ORESKOVICH DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-286-4471
Mailing Address - Street 1:1526 W GLENDALE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8576
Mailing Address - Country:US
Mailing Address - Phone:602-995-7279
Mailing Address - Fax:
Practice Address - Street 1:1526 W GLENDALE AVE STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8576
Practice Address - Country:US
Practice Address - Phone:602-995-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty