Provider Demographics
NPI:1205351392
Name:ARCADIA PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:ARCADIA PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:623-282-9959
Mailing Address - Street 1:20430 N 19TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3590
Mailing Address - Country:US
Mailing Address - Phone:623-282-9959
Mailing Address - Fax:
Practice Address - Street 1:5717 E THOMAS RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7509
Practice Address - Country:US
Practice Address - Phone:480-207-5070
Practice Address - Fax:480-304-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty