Provider Demographics
NPI:1831344167
Name:AROUND THE MOUNTAIN PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:AROUND THE MOUNTAIN PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-779-0385
Mailing Address - Street 1:1024 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3266
Mailing Address - Country:US
Mailing Address - Phone:928-779-0385
Mailing Address - Fax:928-779-6487
Practice Address - Street 1:1024 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3266
Practice Address - Country:US
Practice Address - Phone:928-779-0385
Practice Address - Fax:928-779-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty