Provider Demographics
NPI:1407340854
Name:OCOTILLO LAKES DENTAL HEALTH
Entity Type:Organization
Organization Name:OCOTILLO LAKES DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-283-5854
Mailing Address - Street 1:2947 N POWER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1750
Mailing Address - Country:US
Mailing Address - Phone:480-283-5854
Mailing Address - Fax:480-807-3649
Practice Address - Street 1:3200 S ALMA SCHOOL RD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3755
Practice Address - Country:US
Practice Address - Phone:480-283-5854
Practice Address - Fax:480-807-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty