| Vistancia Orthodontics | |
|
9772 W Yearling Rd Ste A1600 Peoria AZ 85383-1380 | |
| (623) 566-0800 | |
| (833) 330-2854 |
| Full Name | Vistancia Orthodontics |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 9772 W Yearling Rd, Peoria, Arizona |
| Authorized Official Name and Position | Devin Lee Croft (PRESIDENT) |
| Authorized Official Contact | 6235660800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vistancia Orthodontics 9772 W Yearling Rd Ste A1600 Peoria AZ 85383-1380 Ph: (623) 566-0800 | Vistancia Orthodontics 9772 W Yearling Rd Ste A1600 Peoria AZ 85383-1380 Ph: (623) 566-0800 |
| NPI Number | 1225352289 |
|---|---|
| Provider Enumeration Date | 03/19/2010 |
| Last Update Date | 10/13/2023 |
| Medicare PECOS PAC ID | 7113054792 |
|---|---|
| Medicare Enrollment ID | O20100430000265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225352289 | NPI | - | NPPES |
| 162964 | Medicaid | AZ | |
| 518939 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 7616 (Arizona) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Primary |
| Provider Name | Devin L Croft |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659520617 PECOS PAC ID: 9638206410 Enrollment ID: I20100525000434 |
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