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General NPI Number Information
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NPI Number | 1023111838
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Entity Type | Organization
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Legal Business Name | FOOTHILLS FAMILY DENTAL PC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1238 E CHANDLER BLVD SUITE #101
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-460-0484
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Fax | 480-460-0978
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Provider Business Mailing Address
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Address Line | 1238 E CHANDLER BLVD SUITE #101
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-460-0484
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Fax | 480-460-0978
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANITA FELTON MARRA
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Credential | DDS
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Telephone | 480-460-0484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | AZ4340
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License Number State | AZ
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