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General NPI Number Information
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NPI Number | 1013526961
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Entity Type | Organization
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Legal Business Name | AZ FAMILY AND KIDS DENTAL AVONDALE LLC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 10740 W LOWER BUCKEYE RD STE 105
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City | AVONDALE
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State | AZ
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Zip | 85323-9655
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Country | US
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Telephone | 623-439-8045
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Fax | 623-439-8046
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Provider Business Mailing Address
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Address Line | 10740 W LOWER BUCKEYE RD STE 105
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City | AVONDALE
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State | AZ
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Zip | 85323-9655
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Country | US
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Telephone | 623-439-8045
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Fax | 623-439-8046
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | RICHARD SMITH
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Credential | DDS
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Telephone | 480-325-7639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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