| Dba Frontier Dental | |
|
4850 E. Broadway Blvd. Frontier Dental Tucson AZ 85710 | |
| (520) 514-1883 | |
| (520) 514-1997 |
| Full Name | Dba Frontier Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4850 E. Broadway Blvd., Tucson, Arizona |
| Authorized Official Name and Position | Rodney Jene Gold (PRESIDENT) |
| Authorized Official Contact | 5205141883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba Frontier Dental 4850 E. Broadway Blvd Frontier Dental Tucson AZ 85710 Ph: (520) 514-1883 | Dba Frontier Dental 4850 E. Broadway Blvd. Frontier Dental Tucson AZ 85710 Ph: (520) 514-1883 |
| NPI Number | 1407037807 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 04/06/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407037807 | NPI | - | NPPES |
| 092578-006 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | 3398 (Arizona) | Primary |
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