Provider Demographics
NPI:1821323635
Name:NOBUAKI MANAGEMENT
Entity Type:Organization
Organization Name:NOBUAKI MANAGEMENT
Other - Org Name:ENCANTO FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:480-231-7020
Mailing Address - Street 1:1525 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-6102
Mailing Address - Country:US
Mailing Address - Phone:602-263-9039
Mailing Address - Fax:602-263-9071
Practice Address - Street 1:1525 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-6102
Practice Address - Country:US
Practice Address - Phone:602-263-9039
Practice Address - Fax:602-263-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty