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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.

NPI Number 1255695813
LBN Legal business name ADVANCED DENTAL GROUP, INC.
Authorized official PETER SPILOTRO - (OWNER/PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 06/28/2012
Last updated 06/28/2012 - About 14 years ago
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
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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