| Advanced Dental Group, Inc. | |
|
15440 N 7th St Suite 8 Phoenix AZ 85022-3535 | |
| (602) 504-6400 | |
| (602) 504-6300 |
| Full Name | Advanced Dental Group, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 15440 N 7th St, Phoenix, Arizona |
| Authorized Official Name and Position | Peter Spilotro (OWNER/PRESIDENT) |
| Authorized Official Contact | 6236809911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Group, Inc. 7217 W Camino De Oro Peoria AZ 85383-3266 Ph: (602) 504-6400 | Advanced Dental Group, Inc. 15440 N 7th St Suite 8 Phoenix AZ 85022-3535 Ph: (602) 504-6400 |
| NPI Number | 1255695813 |
|---|---|
| Provider Enumeration Date | 06/28/2012 |
| Last Update Date | 06/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255695813 | NPI | - | NPPES |
| 835324 | Medicaid | AZ | |
| 633679 | Medicaid | AZ | |
| 639651 | Medicaid | AZ | |
| 996431 | Other | AZ | UNITED CONCORDIA |
| AZ0414080 | Other | AZ | BLUE CROSS BLUE SHIELD OF AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D4664 (Arizona) | Secondary |
| 122300000X | Dentist | D5123 (Arizona) | Primary |
| 1223E0200X | Dentist - Endodontics | D5915 (Arizona) | Secondary |
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