Provider Demographics
NPI:1265783682
Name:ARIZONA MINI DENTAL IMPLANT CENTERS AT SUN CITY COMMUNITIES, LLC
Entity type:Organization
Organization Name:ARIZONA MINI DENTAL IMPLANT CENTERS AT SUN CITY COMMUNITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:CASELDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-518-2686
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2469
Mailing Address - Country:US
Mailing Address - Phone:623-518-2686
Mailing Address - Fax:623-518-2875
Practice Address - Street 1:14239 W BELL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2469
Practice Address - Country:US
Practice Address - Phone:623-518-2686
Practice Address - Fax:623-518-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty