Healthcare Provider Details

I. General information

NPI: 1194924415
Provider Name (Legal Business Name): HIBA KAMAL DENKHA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15182 N 75TH AVE STE 120
PEORIA AZ
85381-4722
US

IV. Provider business mailing address

15182 N 75TH AVE STE 120
PEORIA AZ
85381-4722
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-2400
  • Fax: 623-878-3151
Mailing address:
  • Phone: 623-878-2400
  • Fax: 623-878-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD 7300
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: