Provider Demographics
NPI:1831588169
Name:COMPASS POINT DENTAL
Entity type:Organization
Organization Name:COMPASS POINT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-242-5741
Mailing Address - Street 1:6750 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1127
Mailing Address - Country:US
Mailing Address - Phone:602-242-5741
Mailing Address - Fax:
Practice Address - Street 1:5400 W NORTHERN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1406
Practice Address - Country:US
Practice Address - Phone:623-500-5790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX PEDIATRIC DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ450924Medicaid