Healthcare Provider Details

I. General information

NPI: 1215910484
Provider Name (Legal Business Name): DHHS-PHS, IHS TUCSON AREA, IHS TUCSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 S J STOCK RD
TUCSON AZ
85746-7012
US

IV. Provider business mailing address

7900 S J STOCK RD
TUCSON AZ
85746-7012
US

V. Phone/Fax

Practice location:
  • Phone: 520-295-2575
  • Fax: 520-295-2574
Mailing address:
  • Phone: 520-295-2503
  • Fax: 520-295-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. ARLENE RAYMOND
Title or Position: BUDGET ANALYST
Credential:
Phone: 520-295-2427