Organization · NPI-2

94th Drive, LLC

Dentist · Peoria, AZ

NPI number1174769590
StatusActive
Last updated in NPPESJan 7, 2009

Details

NPI
1174769590
Entity type
Organization (NPI-2)
Legal business name
94th Drive, LLC
Organization subpart
No
Enumeration date
Jan 7, 2009
Last updated
Jan 7, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X DentistD6772AZYes

Other names

  • Peoria Dentistry (Doing Business As)

Practice location

13660 N 94th Dr
B-1
Peoria, AZ 85381-4836

Phone 623-977-2551 · Fax 623-977-9515

Mailing address

13660 N 94th Dr
B-1
Peoria, AZ 85381-4836

Phone 623-977-2551 · Fax 623-977-9515

Authorized official

Fawne E Pryor
Insurance Manager
6235823902

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