1922303569 NPI number — TOTAL FREEDOM DENTAL IMPLANT CENTER

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 1922303569 NPI number — TOTAL FREEDOM DENTAL IMPLANT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL FREEDOM DENTAL IMPLANT CENTER
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:
1922303569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9002 E DESERT COVE AVE
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-860-9002
Provider Business Mailing Address Fax Number:
480-451-9378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9002 E DESERT COVE AVE
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-860-9002
Provider Business Practice Location Address Fax Number:
480-451-9378
Provider Enumeration Date:
01/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
480-860-9002

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3573 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277697 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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