Provider Demographics
NPI:1891318416
Name:DENTAL CENTER OF SCOTTSDALE PLLC
Entity Type:Organization
Organization Name:DENTAL CENTER OF SCOTTSDALE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMO
Authorized Official - Phone:480-457-0996
Mailing Address - Street 1:6945 E. SAHUARO
Mailing Address - Street 2:DR. STE A-3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-951-3333
Mailing Address - Fax:980-951-0436
Practice Address - Street 1:6945 E. SAHUARO
Practice Address - Street 2:DR. STE A-3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-951-3333
Practice Address - Fax:980-951-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1639230329Medicaid