Organization · NPI-2

A Astra Dentist, INC.

Dentist · Avondale, AZ

NPI number1619009156
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1619009156
Entity type
Organization (NPI-2)
Legal business name
A Astra Dentist, INC.
Organization subpart
No
Enumeration date
Mar 11, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

1453 N Dysart Rd Ste B108
Avondale, AZ 85323-1539

Phone 623-932-9202

Mailing address

1453 N Dysart Rd Ste B108
Avondale, AZ 85323-1539

Phone 623-932-9202

Authorized official

Kuong C Kov
President
6239329202

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