94th Drive, LLC

NPI #1174769590 in Peoria, Arizona

Provider Information

NPI Number: 1174769590
Entity Type: Organization
Organization Name: 94th Drive, LLC
Primary Specialty: Dentist
Enumeration Date: Jan 7, 2009
Last Updated: Jan 7, 2009

Practice Location

Address: 13660 N 94TH DR
Address 2: B-1
City: Peoria
State: Arizona
ZIP Code: 85381-4836
Phone: (623) 977-2551

Authorized Official

Name: MISS FAWNE E PRYOR, MGR
Title: INSURANCE MANAGER
Phone: (623) 582-3902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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