Provider Demographics
NPI:1518179084
Name:STETSON DENTAL GROUP PC
Entity type:Organization
Organization Name:STETSON DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:POYAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-451-0908
Mailing Address - Street 1:9755 N. 90TH ST.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-451-0908
Mailing Address - Fax:481-451-8169
Practice Address - Street 1:9755 N. 90TH ST.
Practice Address - Street 2:SUITE 190
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-451-0908
Practice Address - Fax:481-451-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty