| Grand Canyon Dental, Pllc | |
|
2610 W Baseline Rd Ste 118 Phoenix AZ 85041-6400 | |
| (602) 323-4699 | |
| (602) 323-4699 |
| Full Name | Grand Canyon Dental, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 2610 W Baseline Rd Ste 118, Phoenix, Arizona |
| Authorized Official Name and Position | Leo J Peplinskis Muktans (OWNER) |
| Authorized Official Contact | 6023234699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Canyon Dental, Pllc Po Box 32067 Phoenix AZ 85064-2067 Ph: (602) 323-4699 | Grand Canyon Dental, Pllc 2610 W Baseline Rd Ste 118 Phoenix AZ 85041-6400 Ph: (602) 323-4699 |
| NPI Number | 1245666908 |
|---|---|
| Provider Enumeration Date | 09/25/2013 |
| Last Update Date | 03/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245666908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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