Central Avenue Specialty, PLLC.
Dentist, Endodontics in Phoenix, AZ. Organization (NPI-2).
NPI number1104257963
StatusActive
Last updated in NPPESDec 4, 2013
Details
- NPI
- 1104257963
- Entity type
- Organization (NPI-2)
- Legal business name
- Central Avenue Specialty, PLLC.
- Organization subpart
- No
- Enumeration date
- Dec 4, 2013
- Last updated
- Dec 4, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | D07259 | AZ | Yes |
| 1223P0700X | Dentist, Prosthodontics | D008106 | AZ | |
| 1223P0221X | Dentist, Pediatric Dentistry | D008035 | AZ |
Practice location
5133 N Central AveSuite 200
Phoenix, AZ 85012-1438
Phone 602-266-1776 · Fax 602-234-1814
Mailing address
5133 N Central AveSuite 102
Phoenix, AZ 85012-1438
Phone 602-266-1776 · Fax 602-234-1814
Authorized official
Anthony E Herro
Owner
6022661776
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