Provider Demographics
NPI:1932388188
Name:ARTISAN FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:ARTISAN FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-588-7777
Mailing Address - Street 1:18555 N 59TH AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1255
Mailing Address - Country:US
Mailing Address - Phone:602-588-7777
Mailing Address - Fax:
Practice Address - Street 1:18555 N 59TH AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1255
Practice Address - Country:US
Practice Address - Phone:602-588-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5467261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental