Healthcare Provider Details

I. General information

NPI: 1255043444
Provider Name (Legal Business Name): AZ FAMILY AND KIDS DENTAL TEMPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W BASELINE RD STE 1
TEMPE AZ
85283-5948
US

IV. Provider business mailing address

745 W BASELINE RD STE 1
TEMPE AZ
85283-5948
US

V. Phone/Fax

Practice location:
  • Phone: 480-777-5570
  • Fax:
Mailing address:
  • Phone: 480-777-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL HAUGHT
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 480-777-5570