Healthcare Provider Details

I. General information

NPI: 1619901501
Provider Name (Legal Business Name): SATISH KUMAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAIN ST BLDG B
SOMERTON AZ
85350-7409
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-236-8001
  • Fax:
Mailing address:
  • Phone: 928-662-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4201
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: