Provider Demographics
NPI:1679867162
Name:TATUM CREEK FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:TATUM CREEK FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, DMD
Authorized Official - Phone:480-488-0686
Mailing Address - Street 1:30012 N CAVE CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-488-0686
Mailing Address - Fax:480-488-8586
Practice Address - Street 1:30012 N CAVE CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-488-0686
Practice Address - Fax:480-488-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVD7238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty