| Surprise Pediatric Dentistry, Pc | |
|
15331 W Bell Rd Suite #112 Surprise AZ 85374-4102 | |
| (602) 730-6481 | |
| (602) 730-6482 |
| Full Name | Surprise Pediatric Dentistry, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 15331 W Bell Rd, Surprise, Arizona |
| Authorized Official Name and Position | Mathew O Jensen (DENTIST/OWNER) |
| Authorized Official Contact | 8016567978 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Surprise Pediatric Dentistry, Pc 15331 W Bell Rd Suite #112 Surprise AZ 85374-4102 Ph: (602) 730-6481 | Surprise Pediatric Dentistry, Pc 15331 W Bell Rd Suite #112 Surprise AZ 85374-4102 Ph: (602) 730-6481 |
| NPI Number | 1114462330 |
|---|---|
| Provider Enumeration Date | 12/23/2016 |
| Last Update Date | 12/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114462330 | NPI | - | NPPES |
| 200173 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D008930 (Arizona) | Primary |
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