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Contact Information

ADVANCED DENTAL GROUP, INC.
15440 N 7TH ST
SUITE 8
PHOENIX, AZ85022-3535
 Phone: 602-504-6400
 Fax: 602-504-6300
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for ADVANCED DENTAL GROUP INC · (Female)

NPI Number 1255695813
Status Active
Credentials
Entity Individual
Enumeration date 06/28/2012
Last updated 06/28/2012 - About 14 years ago
Sole proprietor 1 Not specified
Identifiers
  • AZ License # D4664
  • AZ License # D5123
  • AZ License # D5915
  • AZ Medicaid 633679
  • AZ Medicaid 639651
  • AZ Medicaid 835324
  • AZ Other AZ0414080 BLUE CROSS BLUE SHIELD OF AZ
  • AZ Other 996431 UNITED CONCORDIA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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