Healthcare Provider Details

I. General information

NPI: 1164754032
Provider Name (Legal Business Name): ALMA SCHOOL DENTAL MANAGEMENT CO. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 E CHANDLER BLVD STE 104
PHOENIX AZ
85048-0303
US

IV. Provider business mailing address

3961 E CHANDLER BLVD STE 104
PHOENIX AZ
85048-0303
US

V. Phone/Fax

Practice location:
  • Phone: 480-759-4202
  • Fax:
Mailing address:
  • Phone: 480-759-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6458
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6458
License Number StateAZ

VIII. Authorized Official

Name: DR. ERIC LYNN KERBS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 480-759-4202