Provider Demographics
NPI:1639643059
Name:1915 DENTAL PLLC
Entity Type:Organization
Organization Name:1915 DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-398-8408
Mailing Address - Street 1:PO BOX 4562
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-4562
Mailing Address - Country:US
Mailing Address - Phone:520-398-8408
Mailing Address - Fax:
Practice Address - Street 1:2221 E FRONTAGE RD
Practice Address - Street 2:C-101
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646
Practice Address - Country:US
Practice Address - Phone:520-398-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty