Provider Demographics
NPI:1750551842
Name:MICHAEL J. KILLEBREW DENTISTRY PLLC
Entity type:Organization
Organization Name:MICHAEL J. KILLEBREW DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KILLEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-455-5280
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0158
Mailing Address - Country:US
Mailing Address - Phone:520-455-5280
Mailing Address - Fax:520-455-5474
Practice Address - Street 1:3121 S. HIGHWAY 83
Practice Address - Street 2:SUITE D
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637
Practice Address - Country:US
Practice Address - Phone:520-455-5280
Practice Address - Fax:520-455-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty