Provider Demographics
NPI:1528232642
Name:DEHNERT DENTAL LLC
Entity Type:Organization
Organization Name:DEHNERT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-628-2818
Mailing Address - Street 1:4781 E CAMP LOWELL DR
Mailing Address - Street 2:SUITE #121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1289
Mailing Address - Country:US
Mailing Address - Phone:520-628-2818
Mailing Address - Fax:250-319-5513
Practice Address - Street 1:4781 E CAMP LOWELL DR
Practice Address - Street 2:SUITE #121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1289
Practice Address - Country:US
Practice Address - Phone:520-628-2818
Practice Address - Fax:250-319-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty