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General NPI Number Information
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NPI Number | 1023179900
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Entity Type | Organization
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Legal Business Name | CENTRAL DENTISTRY
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1807 THATCHER BLVD
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City | SAFFORD
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State | AZ
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Zip | 85546
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Country | US
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Telephone | 928-428-2750
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Fax | 928-428-9460
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | SAFFORD
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State | AZ
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Zip | 85548
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Country | US
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Telephone | 928-428-2750
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Fax | 928-428-9460
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Authorized Official
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Title or Position | OWNER HYGIENIST
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Name | RYAN S CLUFF
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Credential | RDH AZ LIC NO H4143
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Telephone | 928-428-2750
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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 | D1502
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4223
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3604
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License Number State | AZ
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