Provider Demographics
NPI:1114951308
Name:OCOTILLO DENTAL CARE, PC
Entity Type:Organization
Organization Name:OCOTILLO DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GARELICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-855-1994
Mailing Address - Street 1:3165 S ALMA SCHOOL RD
Mailing Address - Street 2:26
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3760
Mailing Address - Country:US
Mailing Address - Phone:480-855-1994
Mailing Address - Fax:480-855-0486
Practice Address - Street 1:3165 S ALMA SCHOOL RD
Practice Address - Street 2:26
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3760
Practice Address - Country:US
Practice Address - Phone:480-855-1994
Practice Address - Fax:480-855-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty