Provider Demographics
NPI:1477811842
Name:KIDS DENTAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:KIDS DENTAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-833-3330
Mailing Address - Street 1:PO BOX 15387
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5387
Mailing Address - Country:US
Mailing Address - Phone:480-833-3330
Mailing Address - Fax:480-461-0101
Practice Address - Street 1:1305 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2070
Practice Address - Country:US
Practice Address - Phone:480-833-3330
Practice Address - Fax:480-461-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD58021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty