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94th Drive, LLC — NPI 1174769590, Peoria, AZ | NPI Central

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NPI 1174769590

OrganizationActive

94th Drive, LLC

NPI 1174769590 · Dentist · Peoria, AZ

Provider details

NPI number: 1174769590
Entity type: Organization
Primary specialty: DentistDental Providers
Organization subpart: No
Authorized official: Fawne Pryor, Insurance Manager(623) 582-3902
License: D6772 (AZ)

Specialties & taxonomies

DentistPrimary122300000XLicense D6772 (AZ)
Dental Providers

Practice location

13660 N 94th Dr

B-1

Peoria, AZ 85381-4836

Phone: (623) 977-2551

Fax: (623) 977-9515

Approximate (ZIP-level) locationGet directions

More AZ providers

Mailing address

13660 N 94th Dr

Peoria, AZ 85381-4836

Other names (DBA / former)

Doing business as: Peoria Dentistry

Registry dates

Enumerated: 2009-01-07
Last updated: 2009-01-07

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.