Provider Demographics
NPI:1528392891
Name:KIDS DENTAL 2 P.C.
Entity Type:Organization
Organization Name:KIDS DENTAL 2 P.C.
Other - Org Name:KIDS DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-956-2024
Mailing Address - Street 1:3130 E BASELINE RD
Mailing Address - Street 2:#103-104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7290
Mailing Address - Country:US
Mailing Address - Phone:480-813-3423
Mailing Address - Fax:480-718-7387
Practice Address - Street 1:3130 E BASELINE RD
Practice Address - Street 2:#103-104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7290
Practice Address - Country:US
Practice Address - Phone:480-813-3423
Practice Address - Fax:480-718-7387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NBA DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty