Provider Demographics
NPI:1760956189
Name:SOUTHERN DENTAL SPECIALTIES OF TUCSON
Entity Type:Organization
Organization Name:SOUTHERN DENTAL SPECIALTIES OF TUCSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-833-4180
Mailing Address - Street 1:1601 N TUCSON BLVD STE 12C
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 N TUCSON BLVD STE 12C
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3405
Practice Address - Country:US
Practice Address - Phone:520-327-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED DENTAL CARE PROVIDERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty