Provider Demographics
NPI:1720423908
Name:ACACIA ENDODONTICS AT AHWATUKEE
Entity Type:Organization
Organization Name:ACACIA ENDODONTICS AT AHWATUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-777-9938
Mailing Address - Street 1:15215 S 48TH ST STE 136
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9138
Mailing Address - Country:US
Mailing Address - Phone:480-704-8550
Mailing Address - Fax:480-704-0199
Practice Address - Street 1:15215 S 48TH ST STE 136
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9138
Practice Address - Country:US
Practice Address - Phone:480-704-8550
Practice Address - Fax:480-704-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty