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432 E Southern Ave #1 Phoenix AZ 85040-9335 | |
| (602) 268-8808 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 432 E Southern Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Jeremy Garrett (OWNER) |
| Authorized Official Contact | 6022688808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
432 E Southern Ave #1 Phoenix AZ 85040-9335 Ph: (602) 268-8808 | 432 E Southern Ave #1 Phoenix AZ 85040-9335 Ph: (602) 268-8808 |
| NPI Number | 1457735508 |
|---|---|
| Provider Enumeration Date | 07/17/2015 |
| Last Update Date | 07/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457735508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D6959 (Arizona) | Primary |
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