1255043444 NPI number — AZ FAMILY AND KIDS DENTAL TEMPE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255043444 NPI number — AZ FAMILY AND KIDS DENTAL TEMPE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZ FAMILY AND KIDS DENTAL TEMPE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255043444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 W BASELINE RD STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85283-5371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-777-5570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W BASELINE RD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-5371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-777-5570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
PARKER
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
480-777-5570

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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