| Higley Village Kidtastic, Llc | |
|
3303 E Queen Creek Rd Suite # 106 Gilbert AZ 85297-8532 | |
| (480) 648-4037 | |
| (480) 696-5505 |
| Full Name | Higley Village Kidtastic, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3303 E Queen Creek Rd, Gilbert, Arizona |
| Authorized Official Name and Position | Jaime Johnson (CONTROLLER) |
| Authorized Official Contact | 4806484037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Higley Village Kidtastic, Llc 4704 E Southern Ave Mesa AZ 85206-2737 Ph: (480) 648-4037 | Higley Village Kidtastic, Llc 3303 E Queen Creek Rd Suite # 106 Gilbert AZ 85297-8532 Ph: (480) 648-4037 |
| NPI Number | 1447598495 |
|---|---|
| Provider Enumeration Date | 01/25/2013 |
| Last Update Date | 12/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447598495 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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