Provider Demographics
NPI:1053332262
Name:DNC HOLDINGS LLC
Entity Type:Organization
Organization Name:DNC HOLDINGS LLC
Other - Org Name:TINY TEETH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYDEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-776-9700
Mailing Address - Street 1:4244 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5108
Mailing Address - Country:US
Mailing Address - Phone:602-776-9700
Mailing Address - Fax:602-776-9699
Practice Address - Street 1:4244 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5108
Practice Address - Country:US
Practice Address - Phone:602-776-9700
Practice Address - Fax:602-776-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619645Medicaid