Provider Demographics
NPI:1265734701
Name:EAST VALLEY ENDODONTICS
Entity type:Organization
Organization Name:EAST VALLEY ENDODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-988-0020
Mailing Address - Street 1:18610 E RITTENHOUSE RD # A-104
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4503
Mailing Address - Country:US
Mailing Address - Phone:480-988-0020
Mailing Address - Fax:480-988-6208
Practice Address - Street 1:18610 E RITTENHOUSE RD # A-104
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4503
Practice Address - Country:US
Practice Address - Phone:480-988-0020
Practice Address - Fax:480-988-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty