Provider Demographics
NPI:1396957577
Name:OCOTILLO FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:OCOTILLO FAMILY DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIRIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-802-8686
Mailing Address - Street 1:995 E OCOTILLO RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3111
Mailing Address - Country:US
Mailing Address - Phone:480-802-8686
Mailing Address - Fax:480-802-8688
Practice Address - Street 1:995 E OCOTILLO RD
Practice Address - Street 2:SUITE #3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3111
Practice Address - Country:US
Practice Address - Phone:480-802-8686
Practice Address - Fax:480-802-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1886702OtherUCCI
AZ78195OtherDHA
AZ002Medicare ID - Type UnspecifiedMERCY CARE