Provider Demographics
NPI:1932534971
Name:PROGRESSIVE DENTISTRY & ORTHODONTICS LLC
Entity Type:Organization
Organization Name:PROGRESSIVE DENTISTRY & ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-775-8600
Mailing Address - Street 1:4146 NEUMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:520-423-3890
Practice Address - Street 1:2995 W ELLIOT RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1670
Practice Address - Country:US
Practice Address - Phone:480-775-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty