1811108574 NPI number — GENERAL DENTISTRY FOR KIDS

Table of content: (NPI 1811108574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811108574 NPI number — GENERAL DENTISTRY FOR KIDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERAL DENTISTRY FOR KIDS
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:
GENERAL DENTISTRY 4 KIDS
Provider Other Organization Name Type Code:
3
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:
1811108574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8151 E INDIAN BEND RD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-4826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-607-9999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1743 W PRINCE RD
Provider Second Line Business Practice Location Address:
115
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-408-2288
Provider Business Practice Location Address Fax Number:
520-408-3021
Provider Enumeration Date:
05/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
IN-HOUSE COUNSEL
Authorized Official Telephone Number:
480-607-9999

Provider Taxonomy Codes

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

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