Provider Demographics
NPI:1336645340
Name:JUST FOR KIDS DENTAL GROUP KINGMAN, PLLC
Entity Type:Organization
Organization Name:JUST FOR KIDS DENTAL GROUP KINGMAN, PLLC
Other - Org Name:JUST FOR KID DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-718-7188
Mailing Address - Street 1:2401 N STOCKTON HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4189
Mailing Address - Country:US
Mailing Address - Phone:928-718-7188
Mailing Address - Fax:
Practice Address - Street 1:2401 N STOCKTON HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4189
Practice Address - Country:US
Practice Address - Phone:928-718-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty