Provider Demographics
NPI:1295037687
Name:KIDZ CONNEXTION DENTAL CENTER
Entity Type:Organization
Organization Name:KIDZ CONNEXTION DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANETO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-223-1001
Mailing Address - Street 1:4727 E BELL RD
Mailing Address - Street 2:SUITE # 45101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2308
Mailing Address - Country:US
Mailing Address - Phone:623-223-1001
Mailing Address - Fax:623-873-7440
Practice Address - Street 1:2533 N 75TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-1211
Practice Address - Country:US
Practice Address - Phone:623-223-1001
Practice Address - Fax:623-873-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD53761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty