Provider Demographics
NPI:1679844286
Name:TUCSON ENDODONTICS, PLLC
Entity Type:Organization
Organization Name:TUCSON ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-293-1000
Mailing Address - Street 1:1426 W PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3014
Mailing Address - Country:US
Mailing Address - Phone:520-293-1000
Mailing Address - Fax:520-293-1038
Practice Address - Street 1:1426 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3014
Practice Address - Country:US
Practice Address - Phone:520-293-1000
Practice Address - Fax:520-293-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD34131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty