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Federal Route 15 Santa Rosa Village AZ 85634 | |
(520) 383-5570 | |
(520) 383-5572 |
Full Name | |
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Speciality | Dental Assistant |
Location | Federal Route 15, Santa Rosa Village, Arizona |
Authorized Official Name and Position | Kurt Priessman (ACCOUNTING AND BUDGET OFFICER) |
Authorized Official Contact | 5202952427 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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7900 S J Stock Rd Tucson AZ 85746-7012 Ph: (520) 295-2427 | Federal Route 15 Santa Rosa Village AZ 85634 Ph: (520) 383-5570 |
NPI Number | 1164407870 |
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Provider Enumeration Date | 12/14/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164407870 | NPI | - | NPPES |
1770581639 | Other | AZ | FACILITY PROVIDER # |
147141-03 | Medicaid | AZ | |
AZ0209590 | Other | AZ | BC/BSAZ DENTAL PROV NO |
1073502506 | Other | AZ | PHARMACY PROV NO |
0327177 | Other | AZ | NACADP# |
AZ0209630 | Other | AZ | BC/BSAZ PROV NO |