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407 N 4th St Buckeye AZ 85326-2442 | |
| (623) 327-3206 | |
| (623) 327-0563 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 407 N 4th St, Buckeye, Arizona |
| Authorized Official Name and Position | Tracey Dalton (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6236400267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
407 N 4th St Buckeye AZ 85326-2442 Ph: (602) 354-5800 | 407 N 4th St Buckeye AZ 85326-2442 Ph: (623) 327-3206 |
| NPI Number | 1669515300 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 06/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669515300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D4013 (Arizona) | Primary |
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