Provider Demographics
NPI:1780683060
Name:ORTHODONTIC SPECIALISTS OF TUCSON, PC
Entity Type:Organization
Organization Name:ORTHODONTIC SPECIALISTS OF TUCSON, PC
Other - Org Name:DRS. PEARCY & RAKSANAVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEARCY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:520-742-1232
Mailing Address - Street 1:1320 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3115
Mailing Address - Country:US
Mailing Address - Phone:520-742-1232
Mailing Address - Fax:520-742-0925
Practice Address - Street 1:1320 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3115
Practice Address - Country:US
Practice Address - Phone:520-742-1232
Practice Address - Fax:520-742-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty