Provider Demographics
NPI:1578022018
Name:CACTUS DENTAL, LLC
Entity Type:Organization
Organization Name:CACTUS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-363-3322
Mailing Address - Street 1:7440 W CACTUS RD STE A18
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9534
Mailing Address - Country:US
Mailing Address - Phone:623-979-4400
Mailing Address - Fax:623-979-4402
Practice Address - Street 1:7440 W CACTUS RD STE A18
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-9534
Practice Address - Country:US
Practice Address - Phone:623-979-4400
Practice Address - Fax:623-979-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental