Provider Demographics
NPI:1023111838
Name:FOOTHILLS FAMILY DENTAL PC
Entity type:Organization
Organization Name:FOOTHILLS FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:FELTON
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-460-0484
Mailing Address - Street 1:1238 E CHANDLER BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048
Mailing Address - Country:US
Mailing Address - Phone:480-460-0484
Mailing Address - Fax:480-460-0978
Practice Address - Street 1:1238 E CHANDLER BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-460-0484
Practice Address - Fax:480-460-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty