Provider Demographics
NPI:1538590484
Name:MOUNTAIN VIEW ENDODONTICS
Entity type:Organization
Organization Name:MOUNTAIN VIEW ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-907-9400
Mailing Address - Street 1:10750 W MCDOWELL RD STE A250
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5979
Mailing Address - Country:US
Mailing Address - Phone:623-907-9400
Mailing Address - Fax:623-907-9405
Practice Address - Street 1:10750 W MCDOWELL RD STE A250
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5979
Practice Address - Country:US
Practice Address - Phone:623-907-9400
Practice Address - Fax:623-907-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0088091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty