| Casa Grande Pediatric Dentistry | |
|
1968 N Peart Rd Ste 19 Casa Grande AZ 85122-2497 | |
| (520) 421-1400 | |
| (520) 421-1444 |
| Full Name | Casa Grande Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1968 N Peart Rd Ste 19, Casa Grande, Arizona |
| Authorized Official Name and Position | James Johnson (MEMBER) |
| Authorized Official Contact | 5204211400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Casa Grande Pediatric Dentistry 1968 N Peart Rd Ste 19 Casa Grande AZ 85122-2497 Ph: (520) 421-1400 | Casa Grande Pediatric Dentistry 1968 N Peart Rd Ste 19 Casa Grande AZ 85122-2497 Ph: (520) 421-1400 |
| NPI Number | 1932545456 |
|---|---|
| Provider Enumeration Date | 05/13/2013 |
| Last Update Date | 05/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932545456 | NPI | - | NPPES |
| 587800 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D05410 (Arizona) | Primary |
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