Provider Demographics
NPI:1912195165
Name:ARROWHEAD FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:ARROWHEAD FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-561-0100
Mailing Address - Street 1:7777 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2104
Mailing Address - Country:US
Mailing Address - Phone:623-561-0100
Mailing Address - Fax:623-561-9246
Practice Address - Street 1:7777 W DEER VALLEY RD
Practice Address - Street 2:SUITE 160
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2104
Practice Address - Country:US
Practice Address - Phone:623-561-0100
Practice Address - Fax:623-561-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty