Provider Demographics
NPI:1376815779
Name:TMJ OF ARIZONA LLC
Entity Type:Organization
Organization Name:TMJ OF ARIZONA LLC
Other - Org Name:CORE SLEEP SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-866-1429
Mailing Address - Street 1:13821 N 35TH DR
Mailing Address - Street 2:STE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5541
Mailing Address - Country:US
Mailing Address - Phone:602-866-1429
Mailing Address - Fax:602-866-1437
Practice Address - Street 1:13821 N 35TH DR
Practice Address - Street 2:STE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5541
Practice Address - Country:US
Practice Address - Phone:602-866-1429
Practice Address - Fax:602-866-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ152335Medicare PIN