Provider Demographics
NPI:1831675263
Name:MY DENTAL L.L.C.
Entity Type:Organization
Organization Name:MY DENTAL L.L.C.
Other - Org Name:MY DENTAL L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAMOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-388-7049
Mailing Address - Street 1:2001 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2471
Mailing Address - Country:US
Mailing Address - Phone:602-249-9621
Mailing Address - Fax:602-841-1916
Practice Address - Street 1:725 N CENTRAL AVE STE 109
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1659
Practice Address - Country:US
Practice Address - Phone:623-322-4575
Practice Address - Fax:623-322-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty