Provider Demographics
NPI:1780092080
Name:PERFECT TEETH / FLW & 101 P.C.
Entity type:Organization
Organization Name:PERFECT TEETH / FLW & 101 P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:15678 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:SUITE C-125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2093
Mailing Address - Country:US
Mailing Address - Phone:480-661-0066
Mailing Address - Fax:480-661-0044
Practice Address - Street 1:15678 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:SUITE C-125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2093
Practice Address - Country:US
Practice Address - Phone:480-661-0066
Practice Address - Fax:480-661-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty