Provider Demographics
NPI:1982059457
Name:EAST VALLEY DENTAL PROFESSIONALS
Entity Type:Organization
Organization Name:EAST VALLEY DENTAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKMAN-AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-838-3033
Mailing Address - Street 1:2058 S DOBSON RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6454
Mailing Address - Country:US
Mailing Address - Phone:480-838-3033
Mailing Address - Fax:480-838-5738
Practice Address - Street 1:2058 S DOBSON RD
Practice Address - Street 2:SUITE 12
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6454
Practice Address - Country:US
Practice Address - Phone:480-838-3033
Practice Address - Fax:480-838-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty