Provider Demographics
NPI:1396720728
Name:EARL P. DUFFY DDS PC
Entity type:Organization
Organization Name:EARL P. DUFFY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PROFESSIONAL CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-832-5190
Mailing Address - Street 1:107 N GREENFIELD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7802
Mailing Address - Country:US
Mailing Address - Phone:480-832-5190
Mailing Address - Fax:480-654-9900
Practice Address - Street 1:107 N GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7802
Practice Address - Country:US
Practice Address - Phone:480-832-5190
Practice Address - Fax:480-654-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ25641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty