Provider Demographics
NPI:1942456173
Name:LOOKOUT MOUNTAIN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LOOKOUT MOUNTAIN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL DENTIST
Authorized Official - Phone:602-493-0206
Mailing Address - Street 1:1618 E. BELL
Mailing Address - Street 2:#108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-493-0206
Mailing Address - Fax:602-493-2081
Practice Address - Street 1:1618 E. BELL
Practice Address - Street 2:#108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-493-0206
Practice Address - Fax:602-493-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty