Provider Demographics
NPI:1972886646
Name:HEALTHY TEETH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HEALTHY TEETH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARJOT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-878-0117
Mailing Address - Street 1:10630 N 59TH AVE
Mailing Address - Street 2:SUITE#101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1239
Mailing Address - Country:US
Mailing Address - Phone:623-878-0117
Mailing Address - Fax:623-878-6396
Practice Address - Street 1:10630 N 59TH AVE
Practice Address - Street 2:SUITE#101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1239
Practice Address - Country:US
Practice Address - Phone:623-878-0117
Practice Address - Fax:623-878-6396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEORIA CAMELBACKLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD63971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty