Provider Demographics
NPI:1033503859
Name:ARTISTIC DENTISTRY LLC
Entity Type:Organization
Organization Name:ARTISTIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDSC
Authorized Official - Phone:520-745-0030
Mailing Address - Street 1:5639 E 5TH ST
Mailing Address - Street 2:SUITE E-F
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2443
Mailing Address - Country:US
Mailing Address - Phone:520-745-0030
Mailing Address - Fax:520-747-2054
Practice Address - Street 1:5639 E 5TH ST
Practice Address - Street 2:SUITE E-F
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2443
Practice Address - Country:US
Practice Address - Phone:520-745-0030
Practice Address - Fax:520-747-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ057591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty