Basic Information
| Provider Information | |||||||||
| NPI: | 1376101188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMENDARIZ | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 E UNION HILLS DR APT 2118 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850503383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607910731 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5143 W OLIVE AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853024206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239392600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 103741 | CA | N | Dental Providers | Dentist | General Practice | 1223G0001X | D010639 | AZ | Y | Dental Providers | Dentist | General Practice |
No ID Information.