Healthcare Provider Details

I. General information

NPI: 1801557772
Provider Name (Legal Business Name): OKUN FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTHERN AVE STE B1
TEMPE AZ
85282-5410
US

IV. Provider business mailing address

1050 E SOUTHERN AVE STE B1
TEMPE AZ
85282-5410
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-8763
  • Fax:
Mailing address:
  • Phone: 480-967-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FAITH GASKINS
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 972-869-3789