Provider Demographics
NPI:1780957639
Name:BI-LOW DENTAL SERVICE L.L.C.
Entity type:Organization
Organization Name:BI-LOW DENTAL SERVICE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-253-5774
Mailing Address - Street 1:1902 NORTH 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-253-3459
Mailing Address - Fax:602-253-5619
Practice Address - Street 1:1902 NORTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-253-3459
Practice Address - Fax:602-253-5619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BI-LOW DENTAL SERVICE L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty