Fairway Dental Az PLLC
Clinic/Center, Dental in Litchfield Park, AZ. Organization (NPI-2).
NPI number1609730779
StatusActive
Last updated in NPPESDec 22, 2025
Details
- NPI
- 1609730779
- Entity type
- Organization (NPI-2)
- Legal business name
- Fairway Dental Az PLLC
- Organization subpart
- No
- Enumeration date
- Dec 12, 2025
- Certification date
- Dec 22, 2025
- Last updated
- Dec 22, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
250 Village ParkwaySuite 203/204
Litchfield Park, AZ 85340
Phone 623-428-1808 · Fax 623-428-0690
Mailing address
250 Village ParkwaySuite 205
Litchfield Park, AZ 85340
Phone 623-428-1808 · Fax 623-428-0690
Authorized official
Justin Ewell
Owner/Denist
6234281808
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