Provider Demographics
NPI:1922463538
Name:ASSOCIATED DENTAL CARE PROVIDERS
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-732-7941
Mailing Address - Street 1:PO BOX 505078
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5078
Mailing Address - Country:US
Mailing Address - Phone:480-212-0220
Mailing Address - Fax:480-212-0226
Practice Address - Street 1:3160 E QUEEN CREEK RD
Practice Address - Street 2:SUITE #102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8402
Practice Address - Country:US
Practice Address - Phone:480-212-0220
Practice Address - Fax:480-212-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ90371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty