Provider Demographics
NPI:1871785378
Name:JOSEPH S. DOVGAN, DDS, MS. PC
Entity type:Organization
Organization Name:JOSEPH S. DOVGAN, DDS, MS. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SAMO
Authorized Official - Last Name:DOVGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:480-483-9001
Mailing Address - Street 1:10585 N TATUM BLVD
Mailing Address - Street 2:SUITE D132
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1073
Mailing Address - Country:US
Mailing Address - Phone:480-483-9001
Mailing Address - Fax:480-483-1312
Practice Address - Street 1:10585 N TATUM BLVD
Practice Address - Street 2:SUITE D132
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1073
Practice Address - Country:US
Practice Address - Phone:480-483-9001
Practice Address - Fax:480-483-1312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH S. DOVGAN DDS MS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4137261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental