Provider Demographics
NPI:1912038076
Name:MARICOPA FAMILY DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:MARICOPA FAMILY DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-568-9100
Mailing Address - Street 1:44480 WEST HONEYCUTT ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-2909
Mailing Address - Country:US
Mailing Address - Phone:520-568-9100
Mailing Address - Fax:520-568-9190
Practice Address - Street 1:44480 WEST HONEYCUTT ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2909
Practice Address - Country:US
Practice Address - Phone:520-568-9100
Practice Address - Fax:520-568-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56251223G0001X
AZ57691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty