Provider Demographics
NPI:1285845776
Name:A T STILL UNIVERSITY OF HEALTH SCIENCES
Entity Type:Organization
Organization Name:A T STILL UNIVERSITY OF HEALTH SCIENCES
Other - Org Name:ARIZONA SCHOOL OF DENTISTRY & ORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-219-6183
Mailing Address - Street 1:5835 E STILL CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3618
Mailing Address - Country:US
Mailing Address - Phone:480-219-6183
Mailing Address - Fax:480-907-2194
Practice Address - Street 1:5855 E STILL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3618
Practice Address - Country:US
Practice Address - Phone:480-248-8100
Practice Address - Fax:480-248-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD1226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty