Provider Demographics
NPI:1609069574
Name:ASSOCIATED DENTAL CARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL CARE PROVIDERS, LLC
Other - Org Name:ASSOCIATED DENTAL CARE TUCSON W INA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:3773 W INA RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2246
Mailing Address - Country:US
Mailing Address - Phone:520-579-8166
Mailing Address - Fax:
Practice Address - Street 1:3773 W INA RD
Practice Address - Street 2:SUITE 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2246
Practice Address - Country:US
Practice Address - Phone:520-579-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty