Provider Demographics
NPI:1972823888
Name:CARE FOR KIDS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:CARE FOR KIDS OF ARIZONA, LLC
Other - Org Name:ARIZONA'S TOOTH DOCTOR FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-245-8461
Mailing Address - Street 1:2330 N ALMA SCHOOL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2490
Mailing Address - Country:US
Mailing Address - Phone:480-388-3222
Mailing Address - Fax:480-776-6810
Practice Address - Street 1:3301 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7302
Practice Address - Country:US
Practice Address - Phone:602-956-4411
Practice Address - Fax:602-956-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF316261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ240871OtherAHCCCS