Provider Demographics
NPI:1225365703
Name:PERFECT TEETH / ABC P.C.
Entity Type:Organization
Organization Name:PERFECT TEETH / ABC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTILAING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:123 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1914
Mailing Address - Country:US
Mailing Address - Phone:520-798-3384
Mailing Address - Fax:520-791-9311
Practice Address - Street 1:123 S STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1914
Practice Address - Country:US
Practice Address - Phone:520-798-3384
Practice Address - Fax:520-791-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty