Provider Demographics
NPI:1497771877
Name:DENTAL PRIDE
Entity Type:Organization
Organization Name:DENTAL PRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-745-1001
Mailing Address - Street 1:899 N WILMOT RD STE B1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1712
Mailing Address - Country:US
Mailing Address - Phone:520-745-1001
Mailing Address - Fax:520-745-1004
Practice Address - Street 1:899 N WILMOT RD STE B1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-745-1001
Practice Address - Fax:520-745-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty