Provider Demographics
NPI:1578987699
Name:CACTUS DENTAL CARE LLC
Entity Type:Organization
Organization Name:CACTUS DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEPHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-979-4400
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:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2583261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental