Provider Demographics
NPI:1114068228
Name:CARE FOR KIDS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:CARE FOR KIDS OF ARIZONA, LLC
Other - Org Name:ARIZONA'S TOOTH DOCTOR FOR KIDS-GLOBE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-655-8687
Mailing Address - Street 1:410 S SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-1305
Mailing Address - Country:US
Mailing Address - Phone:928-425-0972
Mailing Address - Fax:928-425-0978
Practice Address - Street 1:410 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1305
Practice Address - Country:US
Practice Address - Phone:928-425-0972
Practice Address - Fax:928-425-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty