Provider Demographics
NPI:1811223373
Name:HEARTLAND DENTAL CARE OF ARIZONA, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF ARIZONA, PC
Other - Org Name:SMILE TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5141
Mailing Address - Street 1:10144 W LAKE PLEASANT PKWY STE 11
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9716
Mailing Address - Country:US
Mailing Address - Phone:623-825-3696
Mailing Address - Fax:623-825-3695
Practice Address - Street 1:10144 W LAKE PLEASANT PKWY STE 11
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9716
Practice Address - Country:US
Practice Address - Phone:623-825-3696
Practice Address - Fax:623-825-3695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF ARIZONA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty