Provider Demographics
NPI:1972925147
Name:GENERATION III DENTAL INCORPORATED
Entity Type:Organization
Organization Name:GENERATION III DENTAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-398-6808
Mailing Address - Street 1:16080 N 59TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2339
Mailing Address - Country:US
Mailing Address - Phone:623-398-6808
Mailing Address - Fax:623-240-0683
Practice Address - Street 1:16080 N 59TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2339
Practice Address - Country:US
Practice Address - Phone:623-398-6808
Practice Address - Fax:623-240-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty