Provider Demographics
NPI:1922495977
Name:DED ENTERPRISES ENTERTAINMENT
Entity Type:Organization
Organization Name:DED ENTERPRISES ENTERTAINMENT
Other - Org Name:DAVID EVAN DEN FOUW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:DEN BOER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS
Authorized Official - Phone:602-354-1337
Mailing Address - Street 1:901 S COUNTRY CLUB DR APT 2148
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3590
Mailing Address - Country:US
Mailing Address - Phone:602-354-1337
Mailing Address - Fax:
Practice Address - Street 1:901 S COUNTRY CLUB DR APT 2148
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3590
Practice Address - Country:US
Practice Address - Phone:602-354-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07408423251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health