Provider Demographics
NPI:1114333739
Name:89A DENTAL CARE PLLC
Entity Type:Organization
Organization Name:89A DENTAL CARE PLLC
Other - Org Name:89A DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-642-3989
Mailing Address - Street 1:6455 N VIEWPOINT DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3215
Mailing Address - Country:US
Mailing Address - Phone:928-775-8989
Mailing Address - Fax:928-775-8988
Practice Address - Street 1:6455 N VIEWPOINT DR
Practice Address - Street 2:SUITE 600
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-3215
Practice Address - Country:US
Practice Address - Phone:928-775-8989
Practice Address - Fax:928-775-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20570660-N1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ488902Medicaid