Provider Demographics
NPI:1134568637
Name:DANTAL DENTAL CORPORATION
Entity type:Organization
Organization Name:DANTAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:MOSHE
Authorized Official - Last Name:GAFNI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-664-1449
Mailing Address - Street 1:500 W SOUTHERN AVE
Mailing Address - Street 2:#1-3
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W SOUTHERN AVE
Practice Address - Street 2:#1-3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5016
Practice Address - Country:US
Practice Address - Phone:480-664-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8139125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Multi-Specialty