| Desert Ridge Pediatric Dentistry | |
|
5315 E. High Street Suite 115 Phoenix AZ 85054 | |
| (480) 585-5868 | |
| (480) 585-1208 |
| Full Name | Desert Ridge Pediatric Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5315 E. High Street, Phoenix, Arizona |
| Authorized Official Name and Position | Lidieth R Libby (OWNER) |
| Authorized Official Contact | 4805855868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Ridge Pediatric Dentistry 5315 E High St Suite 115 Phoenix AZ 85054-5438 Ph: (480) 585-5868 | Desert Ridge Pediatric Dentistry 5315 E. High Street Suite 115 Phoenix AZ 85054 Ph: (480) 585-5868 |
| NPI Number | 1811176860 |
|---|---|
| Provider Enumeration Date | 10/26/2007 |
| Last Update Date | 07/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811176860 | NPI | - | NPPES |
| 632481 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5548 (Arizona) | Primary |
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