| Northern Avenue Dentistry | |
|
2715 W Northern Ave #102 Phoenix AZ 85051-6641 | |
| (602) 995-0280 | |
| (602) 864-9161 |
| Full Name | Northern Avenue Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2715 W Northern Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Gordon D Gross (OWNER) |
| Authorized Official Contact | 6029950280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Avenue Dentistry 2715 W Northern Ave #102 Phoenix AZ 85051-6641 Ph: (602) 995-0280 | Northern Avenue Dentistry 2715 W Northern Ave #102 Phoenix AZ 85051-6641 Ph: (602) 995-0280 |
| NPI Number | 1548482300 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548482300 | NPI | - | NPPES |
| 824144 | Other | AZ | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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