Provider Demographics
NPI:1790907004
Name:GENERAL DENTISTRY 4 KIDS-TUCSON
Entity Type:Organization
Organization Name:GENERAL DENTISTRY 4 KIDS-TUCSON
Other - Org Name:GENERAL DENTISTRY 4 KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IN-HOUSE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TANN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:480-607-9999
Mailing Address - Street 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-607-9999
Mailing Address - Fax:
Practice Address - Street 1:2102 N COUNTRY CLUB RD
Practice Address - Street 2:STE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2831
Practice Address - Country:US
Practice Address - Phone:520-323-1400
Practice Address - Fax:520-547-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty