Healthcare Provider Details

I. General information

NPI: 1174695498
Provider Name (Legal Business Name): TITO RENE CONTRERAS RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 INA RD.
TUCSON AZ
85741
US

IV. Provider business mailing address

3013 W BAYLEAF DR
TUCSON AZ
85741-3325
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-9500
  • Fax:
Mailing address:
  • Phone: 520-297-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5739
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: