Rustic Mountain Dentistry | |
606 N Main Street Taylor AZ 85939-8593 | |
(928) 457-0758 | |
(928) 457-0821 |
Full Name | Rustic Mountain Dentistry |
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Speciality | Clinic/center - Dental |
Location | 606 N Main Street, Taylor, Arizona |
Authorized Official Name and Position | Kenneth Houston Davis (DOCTOR/OWNER) |
Authorized Official Contact | 9284570758 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Rustic Mountain Dentistry Po Box 1550 Taylor AZ 85939-1550 Ph: (928) 457-0758 | Rustic Mountain Dentistry 606 N Main Street Taylor AZ 85939-8593 Ph: (928) 457-0758 |
NPI Number | 1063983245 |
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Provider Enumeration Date | 12/16/2018 |
Last Update Date | 12/16/2018 |
Identifier | Type | State | Issuer |
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1063983245 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |