Provider Demographics
NPI:1942410741
Name:TUSCANO DENTAL
Entity Type:Organization
Organization Name:TUSCANO DENTAL
Other - Org Name:TUSCANO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PHUOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-907-9334
Mailing Address - Street 1:4017 N. 75TH AVE,
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033
Mailing Address - Country:US
Mailing Address - Phone:623-907-9334
Mailing Address - Fax:623-474-2876
Practice Address - Street 1:4017 N. 75TH AVE,
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:623-907-9334
Practice Address - Fax:623-474-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5995261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ411608Medicaid