Provider Demographics
NPI:1932694817
Name:VALUE DENTAL DMSO LLC
Entity Type:Organization
Organization Name:VALUE DENTAL DMSO LLC
Other - Org Name:VALUE DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEVERN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-449-0881
Mailing Address - Street 1:1628 E SOUTHERN AVE STE 9-232
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5782
Mailing Address - Country:US
Mailing Address - Phone:702-449-0881
Mailing Address - Fax:
Practice Address - Street 1:2750 E GERMANN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1403
Practice Address - Country:US
Practice Address - Phone:480-626-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental