Provider Demographics
NPI:1033587985
Name:HD TUCSON DENTAL LLC
Entity Type:Organization
Organization Name:HD TUCSON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PRACTICE START UP
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-714-6555
Mailing Address - Street 1:5577 N ORACLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3877
Mailing Address - Country:US
Mailing Address - Phone:520-777-0616
Mailing Address - Fax:
Practice Address - Street 1:5577 N ORACLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3877
Practice Address - Country:US
Practice Address - Phone:520-777-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALF DENTAL FRANCHISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty