Provider Demographics
NPI:1407280241
Name:TOOTH CASTLE PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:TOOTH CASTLE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-841-4400
Mailing Address - Street 1:PO BOX 32830
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-2830
Mailing Address - Country:US
Mailing Address - Phone:602-841-4400
Mailing Address - Fax:
Practice Address - Street 1:10740 W LOWER BUCKEYE RD STE 105
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9655
Practice Address - Country:US
Practice Address - Phone:602-841-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD60641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty