Provider Demographics
NPI:1588228373
Name:ARIZONA DENTAL MANAGEMENT
Entity Type:Organization
Organization Name:ARIZONA DENTAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-877-8110
Mailing Address - Street 1:3515 WEST SOUTHERN AVENUE
Mailing Address - Street 2:SUITE #152
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041
Mailing Address - Country:US
Mailing Address - Phone:602-268-0006
Mailing Address - Fax:602-268-0007
Practice Address - Street 1:3515 WEST SOUTHERN AVENUE
Practice Address - Street 2:SUITE #152
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041
Practice Address - Country:US
Practice Address - Phone:602-268-0006
Practice Address - Fax:602-268-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty