Provider Demographics
NPI:1912265158
Name:DENTAL FACIAL IMAGING, LLC
Entity Type:Organization
Organization Name:DENTAL FACIAL IMAGING, LLC
Other - Org Name:DBA: DENTAL IMAGING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-945-3833
Mailing Address - Street 1:7054 E COCHISE RD STE B105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4551
Mailing Address - Country:US
Mailing Address - Phone:480-945-3833
Mailing Address - Fax:480-945-0498
Practice Address - Street 1:7054 E COCHISE RD STE B105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4551
Practice Address - Country:US
Practice Address - Phone:480-945-3833
Practice Address - Fax:480-945-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7-D-3233292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory