Organization · NPI-2

Brivadental LLC

Clinic/Center · Peoria, AZ

NPI number1043645765
StatusActive
Last updated in NPPESNov 12, 2020

Details

NPI
1043645765
Entity type
Organization (NPI-2)
Legal business name
Brivadental LLC
Organization subpart
No
Enumeration date
Sep 12, 2013
Certification date
Nov 12, 2020
Last updated
Nov 12, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/CenterD07658AZYes

Other names

  • Az Cosmetic & Family Dentistry (Doing Business As)

Practice location

13695 N 75th Ave
Peoria, AZ 85381-6098

Phone 602-439-1101 · Fax 602-789-1653

Mailing address

13695 N 75th Ave
Peoria, AZ 85381-6098

Phone 602-439-1101 · Fax 602-789-1653

Authorized official

Vasudha Narra
Owner
6024391101

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