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100 North Gila Boulevard Gila Bend AZ 85227-2658 | |
(602) 263-1511 | |
(602) 263-1619 |
Full Name | |
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Speciality | Dentist |
Location | 100 North Gila Boulevard, Gila Bend, Arizona |
Authorized Official Name and Position | Deanna J. Dick ((CEO) CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 6022631567 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 31001-0698 Pasadena CA 91110-0698 Ph: (602) 263-1511 | 100 North Gila Boulevard Gila Bend AZ 85227-2658 Ph: (602) 263-1511 |
NPI Number | 1780730549 |
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Provider Enumeration Date | 01/26/2007 |
Last Update Date | 06/19/2019 |
Identifier | Type | State | Issuer |
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1780730549 | NPI | - | NPPES |
812851 | Medicaid | AZ |