| Arizona Department Of Health Services | |
|
150 N 18th Avenue, Suite 320 Phoenix AZ 85007-3205 | |
| (602) 542-1866 | |
| (602) 364-1494 |
| Full Name | Arizona Department Of Health Services |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 150 N 18th Avenue, Suite 320, Phoenix, Arizona |
| Authorized Official Name and Position | James H Humble (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6023640679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona Department Of Health Services 150 N 18th Avenue, Suite 320 Phoenix AZ 85007-3205 Ph: (602) 542-1866 | Arizona Department Of Health Services 150 N 18th Avenue, Suite 320 Phoenix AZ 85007-3205 Ph: (602) 542-1866 |
| NPI Number | 1538593157 |
|---|---|
| Provider Enumeration Date | 08/30/2013 |
| Last Update Date | 08/30/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538593157 | NPI | - | NPPES |
| 703886 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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