Provider Demographics
NPI:1023801297
Name:ARIZONA DENTAL PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:ARIZONA DENTAL PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULI
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MIETZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:20540 S SIGNAL BUTTE RD # 106
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-0538
Mailing Address - Country:US
Mailing Address - Phone:602-922-9527
Mailing Address - Fax:602-922-2847
Practice Address - Street 1:20540 S SIGNAL BUTTE RD # 106
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-0538
Practice Address - Country:US
Practice Address - Phone:602-922-9527
Practice Address - Fax:602-922-2847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA DENTAL PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty