Provider Demographics
NPI:1366167439
Name:PV DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PV DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:10555 N TATUM BLVD STE A104
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1096
Mailing Address - Country:US
Mailing Address - Phone:480-998-7775
Mailing Address - Fax:480-948-4098
Practice Address - Street 1:10555 N TATUM BLVD STE A104
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1096
Practice Address - Country:US
Practice Address - Phone:480-998-7775
Practice Address - Fax:480-948-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty