| Lake Powell Dental Center, Pc | |
|
436 Vista Avenue Box 1956 Page AZ 86040 | |
| (928) 645-2505 | |
| (928) 645-6820 |
| Full Name | Lake Powell Dental Center, Pc |
|---|---|
| Speciality | Dentist |
| Location | 436 Vista Avenue, Page, Arizona |
| Authorized Official Name and Position | Jeffrey S Gifford (OWNER) |
| Authorized Official Contact | 9286452505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Powell Dental Center, Pc 436 Vista Page AZ 86040-1956 Ph: (928) 645-2505 | Lake Powell Dental Center, Pc 436 Vista Avenue Box 1956 Page AZ 86040 Ph: (928) 645-2505 |
| NPI Number | 1407392590 |
|---|---|
| Provider Enumeration Date | 01/12/2017 |
| Last Update Date | 01/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407392590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2639 (Arizona) | Primary |
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