Provider Demographics
NPI:1205498938
Name:TUCSON DENTAL STUDIO, PLLC
Entity type:Organization
Organization Name:TUCSON DENTAL STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:SPADER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-326-5442
Mailing Address - Street 1:1331 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4040
Mailing Address - Country:US
Mailing Address - Phone:520-326-5442
Mailing Address - Fax:
Practice Address - Street 1:1331 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4040
Practice Address - Country:US
Practice Address - Phone:520-326-5442
Practice Address - Fax:520-326-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty