Provider Demographics
NPI:1114146743
Name:KI NGO DMD PC
Entity Type:Organization
Organization Name:KI NGO DMD PC
Other - Org Name:DOBSON WARNER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-917-0181
Mailing Address - Street 1:2051 W WARNER RD
Mailing Address - Street 2:SUITE #23
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2100
Mailing Address - Country:US
Mailing Address - Phone:480-917-0181
Mailing Address - Fax:480-917-2806
Practice Address - Street 1:2051 W WARNER RD
Practice Address - Street 2:SUITE #23
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2100
Practice Address - Country:US
Practice Address - Phone:480-917-0181
Practice Address - Fax:480-917-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1778733OtherUCCI
AZF03150Medicare ID - Type UnspecifiedPHOENIX HEALTH PLAN
AZ1778733OtherUCCI