Provider Demographics
NPI:1164754032
Name:ALMA SCHOOL DENTAL MANAGEMENT CO. PC
Entity Type:Organization
Organization Name:ALMA SCHOOL DENTAL MANAGEMENT CO. PC
Other - Org Name:MOUNTAINSIDE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KERBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-759-4202
Mailing Address - Street 1:3961 E CHANDLER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:480-759-4202
Mailing Address - Fax:
Practice Address - Street 1:3961 E CHANDLER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0303
Practice Address - Country:US
Practice Address - Phone:480-759-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6458122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty