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1427 N Arizona Blvd Coolidge AZ 85128-3214 | |
| (520) 723-1700 | |
| (520) 723-1702 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1427 N Arizona Blvd, Coolidge, Arizona |
| Authorized Official Name and Position | Christopher Anthony Ballew (OWNER) |
| Authorized Official Contact | 5207231700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1427 N Arizona Blvd Coolidge AZ 85128-3214 Ph: (520) 723-1700 | 1427 N Arizona Blvd Coolidge AZ 85128-3214 Ph: (520) 723-1700 |
| NPI Number | 1154798064 |
|---|---|
| Provider Enumeration Date | 08/26/2015 |
| Last Update Date | 08/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154798064 | NPI | - | NPPES |
| 1134383631 | Other | AZ | PROVIDER NPI |
| D07579 | Other | AZ | DENTAL LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D07579 (Arizona) | Primary |
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