Healthcare Provider Details

I. General information

NPI: 1780683060
Provider Name (Legal Business Name): ORTHODONTIC SPECIALISTS OF TUCSON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W INA RD
TUCSON AZ
85704-3115
US

IV. Provider business mailing address

1320 W INA RD
TUCSON AZ
85704-3115
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-1232
  • Fax: 520-742-0925
Mailing address:
  • Phone: 520-742-1232
  • Fax: 520-742-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4095
License Number StateAZ

VIII. Authorized Official

Name: DR. DANIEL E PEARCY
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 520-742-1232