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1.5 Mile N Of Leupp Chapter House Leupp AZ 86032 | |
(928) 686-6554 | |
(928) 686-6566 |
Full Name | |
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Speciality | Clinic/center |
Location | 1.5 Mile N Of Leupp Chapter House, Leupp, Arizona |
Authorized Official Name and Position | Thomas Barnes (CHIEF OF DENTAL) |
Authorized Official Contact | 9282894646 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 400 Winslow AZ 86047-0400 Ph: (928) 686-6554 | 1.5 Mile N Of Leupp Chapter House Leupp AZ 86032 Ph: (928) 686-6554 |
NPI Number | 1497925218 |
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Provider Enumeration Date | 03/07/2008 |
Last Update Date | 10/10/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497925218 | NPI | - | NPPES |
758526 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Arizona) | Primary |