Provider Demographics
NPI:1386847218
Name:ARIZONA DENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:ARIZONA DENTAL HEALTH, INC.
Other - Org Name:JEFFREY B. PICO DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PICO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-926-1899
Mailing Address - Street 1:2500 S. POWER RD. STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-926-1899
Mailing Address - Fax:480-926-3177
Practice Address - Street 1:2500 S. POWER RD. STE. 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-926-1899
Practice Address - Fax:480-926-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4229261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental