Provider Demographics
NPI:1861632614
Name:CAMELBACK FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:CAMELBACK FAMILY DENTISTRY, LLC
Other - Org Name:CAMELBACK COSMETIC & FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIRIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-558-1037
Mailing Address - Street 1:67 NORTH DOBSON ROAD
Mailing Address - Street 2:SUITE A104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-668-1190
Mailing Address - Fax:
Practice Address - Street 1:67 NORTH DOBSON ROAD
Practice Address - Street 2:SUITE A104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-668-1190
Practice Address - Fax:480-668-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty