1588200265 NPI number — SIGNAL BUTTE KIDS DENTISTRY AND ORTHODONTICS, LLP

Table of content: (NPI 1588200265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588200265 NPI number — SIGNAL BUTTE KIDS DENTISTRY AND ORTHODONTICS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNAL BUTTE KIDS DENTISTRY AND ORTHODONTICS, LLP
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:
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Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1588200265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17000 RED HILL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92614-5626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10664 E. POINT TWENTY TWO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-480-3603
Provider Business Practice Location Address Fax Number:
480-448-3813
Provider Enumeration Date:
11/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RICHTSTEIG
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-360-3073

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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