Basic Information
| Provider Information | |||||||||
| NPI: | 1083767768 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST VALLEY PEDIATRIC DENTISTRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13575 W INDIAN SCHOOL RD STE 1000 | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853404926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
| FaxNumber: | 6239353626 | ||||||||
| Practice Location | |||||||||
| Address1: | 13575 W INDIAN SCHOOL RD STE 1000 | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853404926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
| FaxNumber: | 6239353626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | BROWNSTEIN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | NEIL | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6239359873 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | D5164 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.