Healthcare Provider Details

I. General information

NPI: 1205961166
Provider Name (Legal Business Name): ALL FAMILY DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W CENTRAL AVE
COOLIDGE AZ
85228-4708
US

IV. Provider business mailing address

PO BOX 1546
COOLIDGE AZ
85228-1546
US

V. Phone/Fax

Practice location:
  • Phone: 520-723-1111
  • Fax:
Mailing address:
  • Phone: 520-723-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6633
License Number StateAZ

VIII. Authorized Official

Name: DR. MAX A ALMODOVAR
Title or Position: OWNER
Credential: DMD
Phone: 602-391-6649