CORE FAMILY DENTAL NPI 1689283814

NPI Information

NPI: 1689283814
Provider Name: CORE FAMILY DENTAL
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
13460 N 94TH DR STE K4
PEORIA, AZ
ZIP 85381
Phone: (232) 231-0366
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CORE FAMILY DENTAL is a dental clinic center in Peoria, AZ. CORE FAMILY DENTAL NPI is 1689283814. The provider is registered as an organization entity type.

The provider's business location address is:

13460 N 94TH DR STE K4
PEORIA, AZ
ZIP 85381-249
Phone: (232) 231-0366

The provider's authorized official is Marvin Blane Jackson .
The authorized official title is Owner and has the following contact phone number (435) 637-2100.

The enumeration date for this NPI number is 7/23/2020 and was last updated on 7/28/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	586868	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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