Provider Demographics
NPI:1407137789
Name:ARROWHEAD CHILDRENS DENTISTRY, PLC
Entity Type:Organization
Organization Name:ARROWHEAD CHILDRENS DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-825-0100
Mailing Address - Street 1:18700 N 64TH DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7109
Mailing Address - Country:US
Mailing Address - Phone:623-825-0100
Mailing Address - Fax:623-825-0409
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7109
Practice Address - Country:US
Practice Address - Phone:623-825-0100
Practice Address - Fax:623-825-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty