Provider Demographics
NPI:1922796226
Name:TKO DENTISTRY
Entity Type:Organization
Organization Name:TKO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYTKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-969-0889
Mailing Address - Street 1:7845 W FETLOCK TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6296
Mailing Address - Country:US
Mailing Address - Phone:509-969-0889
Mailing Address - Fax:
Practice Address - Street 1:8573 E PRINCESS DR # B-201
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:509-969-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental