Provider Demographics
NPI:1134833502
Name:TOTALLY KIDS DENTAL P.C.
Entity type:Organization
Organization Name:TOTALLY KIDS DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH, MS
Authorized Official - Phone:602-610-5088
Mailing Address - Street 1:3825 N 75TH AVE STE 101&102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-3700
Mailing Address - Country:US
Mailing Address - Phone:602-610-5088
Mailing Address - Fax:602-806-8910
Practice Address - Street 1:3825 N 75TH AVE STE 101&102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3700
Practice Address - Country:US
Practice Address - Phone:602-610-5088
Practice Address - Fax:602-806-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D010661OtherLICENSE