| NPI | 1548482300 |
|---|---|
| Doing Business As | NORTHERN AVENUE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | GORDON D GROSS Owner 602-995-0280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |