Provider Demographics
NPI:1285228668
Name:ARIZONA TONGUE TIE CENTER
Entity Type:Organization
Organization Name:ARIZONA TONGUE TIE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-300-4559
Mailing Address - Street 1:7730 E GREENWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1787
Mailing Address - Country:US
Mailing Address - Phone:520-508-5332
Mailing Address - Fax:480-447-8890
Practice Address - Street 1:2700 E FRY BLVD STE B1-E
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2826
Practice Address - Country:US
Practice Address - Phone:480-300-4559
Practice Address - Fax:480-447-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty