Healthcare Provider Details

I. General information

NPI: 1609045855
Provider Name (Legal Business Name): DONALD R PRESTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 SIBYL RD
ST DAVID AZ
85630
US

IV. Provider business mailing address

249 SIBYL RD
ST DAVID AZ
85630
US

V. Phone/Fax

Practice location:
  • Phone: 520-720-4464
  • Fax:
Mailing address:
  • Phone: 520-720-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberAZ1502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: