Provider Demographics
NPI:1770598161
Name:ANTHEM DENTISTRY LLC
Entity type:Organization
Organization Name:ANTHEM DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIATIK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-439-2280
Mailing Address - Street 1:34225 N 27TH DRIVE
Mailing Address - Street 2:#241
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6091
Mailing Address - Country:US
Mailing Address - Phone:623-439-2280
Mailing Address - Fax:480-888-7222
Practice Address - Street 1:3668 W ANTHEM WAY
Practice Address - Street 2:#162
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0468
Practice Address - Country:US
Practice Address - Phone:623-551-7500
Practice Address - Fax:623-551-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty