Provider Demographics
NPI:1649903469
Name:DANI DENTAL STUDIO
Entity type:Organization
Organization Name:DANI DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT EXEC
Authorized Official - Prefix:
Authorized Official - First Name:GABIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-561-6566
Mailing Address - Street 1:1243 E BROADWAY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1530
Mailing Address - Country:US
Mailing Address - Phone:480-449-0909
Mailing Address - Fax:
Practice Address - Street 1:1243 E BROADWAY RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1530
Practice Address - Country:US
Practice Address - Phone:480-449-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ08485220OtherDENTAL LAB