Provider Demographics
NPI:1518178276
Name:GENERAL DENTAL 4 KIDS
Entity Type:Organization
Organization Name:GENERAL DENTAL 4 KIDS
Other - Org Name:GENERAL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-458-2520
Mailing Address - Street 1:1729 PASEO SAN LUIS
Mailing Address - Street 2:B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4611
Mailing Address - Country:US
Mailing Address - Phone:520-458-2520
Mailing Address - Fax:520-459-7877
Practice Address - Street 1:1729 PASEO SAN LUIS
Practice Address - Street 2:B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4611
Practice Address - Country:US
Practice Address - Phone:520-458-2520
Practice Address - Fax:520-459-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty