Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D5353 | AZ |
NPI | 1043294424 |
---|---|
Provider Name | Dr. Brian William Allmendinger |
First Address | Paradise Valley, AZ 85253 |
Second Address | Chandler, AZ 85224-5667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
570475 | A.H.C.C.C.S. (01) | AZ |