Provider Demographics
NPI:1114639648
Name:AERIS DENTAL DOWNTOWN LLC
Entity Type:Organization
Organization Name:AERIS DENTAL DOWNTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-886-8503
Mailing Address - Street 1:1160 N PANTANO RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5126
Mailing Address - Country:US
Mailing Address - Phone:520-886-8503
Mailing Address - Fax:520-885-6660
Practice Address - Street 1:1 E CONGRESS ST STE 153
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1726
Practice Address - Country:US
Practice Address - Phone:520-448-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AERIS FAMILY DENTAL MANAGEMENT PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty