Provider Demographics
NPI:1558567743
Name:TWINE, PERCY B (DMD)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:B
Last Name:TWINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W BASELINE RD STE 172
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6573
Mailing Address - Country:US
Mailing Address - Phone:602-276-3010
Mailing Address - Fax:480-998-9289
Practice Address - Street 1:2020 W BASELINE RD STE 172
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6573
Practice Address - Country:US
Practice Address - Phone:602-276-3010
Practice Address - Fax:602-276-3013
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics