Healthcare Provider Details

I. General information

NPI: 1821268475
Provider Name (Legal Business Name): AFFORDABLE DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10839 E APACHE TRL
APACHE JUNCTION AZ
85220-3414
US

IV. Provider business mailing address

10839 E APACHE TRL
APACHE JUNCTION AZ
85220-3414
US

V. Phone/Fax

Practice location:
  • Phone: 480-354-6177
  • Fax: 480-354-6176
Mailing address:
  • Phone: 480-354-6177
  • Fax: 480-354-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOLORES R YBARRA
Title or Position: OWNER
Credential:
Phone: 480-354-6177