| Tiny Teeth Dental Care | |
|
4244 N 19th Ave Phoenix AZ 85015-5108 | |
| (602) 776-9700 | |
| (602) 776-9699 |
| Full Name | Tiny Teeth Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4244 N 19th Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Dan L Nydegger (OWNER) |
| Authorized Official Contact | 6027769700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tiny Teeth Dental Care 4244 N 19th Ave Phoenix AZ 85015-5108 Ph: (602) 776-9700 | Tiny Teeth Dental Care 4244 N 19th Ave Phoenix AZ 85015-5108 Ph: (602) 776-9700 |
| NPI Number | 1053332262 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053332262 | NPI | - | NPPES |
| 619645 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5540 (Arizona) | Primary |
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