Provider Demographics
NPI:1982379392
Name:MOUNT GRAHAM DENTAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:MOUNT GRAHAM DENTAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-428-5331
Mailing Address - Street 1:1530 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4051
Mailing Address - Country:US
Mailing Address - Phone:928-428-5331
Mailing Address - Fax:928-428-0992
Practice Address - Street 1:1530 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4051
Practice Address - Country:US
Practice Address - Phone:928-428-5331
Practice Address - Fax:928-428-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental