Organization · NPI-2

A 19th Avenue Dental Care

Dentist · Phoenix, AZ

NPI number1356501662
StatusActive
Last updated in NPPESJun 10, 2008

Details

NPI
1356501662
Entity type
Organization (NPI-2)
Legal business name
A 19th Avenue Dental Care
Organization subpart
No
Enumeration date
Jun 10, 2008
Last updated
Jun 10, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

5225 N 19th Avenue
#c
Phoenix, AZ 85015

Phone 602-433-0313 · Fax 602-433-9343

Mailing address

5225 N 19th Avenue
#c
Phoenix, AZ 85015

Phone 602-433-0313 · Fax 602-433-9343

Authorized official

Marc S Kay
Owner
6024330313

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