Provider Demographics
NPI:1922177948
Name:CHILDREN'S DENTAL VILLAGE, P.C.
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL VILLAGE, P.C.
Other - Org Name:CHILDREN'S DENTAL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-838-6949
Mailing Address - Street 1:7360 S MCCLINTOCK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5001
Mailing Address - Country:US
Mailing Address - Phone:480-838-6949
Mailing Address - Fax:480-838-0092
Practice Address - Street 1:7360 S MCCLINTOCK DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5001
Practice Address - Country:US
Practice Address - Phone:480-838-6949
Practice Address - Fax:480-838-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty