Provider Demographics
NPI:1851424287
Name:ASSOCIATED FAMILY DENTISTRY LTD
Entity Type:Organization
Organization Name:ASSOCIATED FAMILY DENTISTRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-931-9221
Mailing Address - Street 1:9160 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3801
Mailing Address - Country:US
Mailing Address - Phone:623-931-9221
Mailing Address - Fax:632-937-4315
Practice Address - Street 1:9160 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3801
Practice Address - Country:US
Practice Address - Phone:623-931-9221
Practice Address - Fax:632-937-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19261223G0001X
AZ43151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty