Provider Demographics
NPI:1639247315
Name:ACADEMY DENTAL CARE PC
Entity Type:Organization
Organization Name:ACADEMY DENTAL CARE PC
Other - Org Name:CHARLES E PICK DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-298-2379
Mailing Address - Street 1:310 N WILMOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2626
Mailing Address - Country:US
Mailing Address - Phone:520-298-2379
Mailing Address - Fax:
Practice Address - Street 1:310 N WILMOT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2626
Practice Address - Country:US
Practice Address - Phone:520-298-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES E PICK DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty