Provider Demographics
NPI:1851510648
Name:ORTHODONTIC CENTERS OF AZ
Entity Type:Organization
Organization Name:ORTHODONTIC CENTERS OF AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PC
Authorized Official - Phone:623-486-2700
Mailing Address - Street 1:7545 W BELL RD
Mailing Address - Street 2:#106
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3832
Mailing Address - Country:US
Mailing Address - Phone:623-486-2700
Mailing Address - Fax:623-486-2406
Practice Address - Street 1:7545 W BELL RD
Practice Address - Street 2:#106
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3832
Practice Address - Country:US
Practice Address - Phone:623-486-2700
Practice Address - Fax:623-486-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty