Provider Demographics
NPI:1316217151
Name:TUCSON SENIOR DENTISTRY
Entity Type:Organization
Organization Name:TUCSON SENIOR DENTISTRY
Other - Org Name:STEVEN F. KAMMEYER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:KAMMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-293-4510
Mailing Address - Street 1:501 W. WETMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1521
Mailing Address - Country:US
Mailing Address - Phone:520-293-4510
Mailing Address - Fax:520-887-8313
Practice Address - Street 1:501 W. WETMORE ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1521
Practice Address - Country:US
Practice Address - Phone:520-293-4510
Practice Address - Fax:520-887-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2513305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service