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General NPI Number Information
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NPI Number | 1023432820
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Entity Type | Organization
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Legal Business Name | CIVANO DENTAL CARE PC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 10501 E SEVEN GENERATIONS WAY 155
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City | TUCSON
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State | AZ
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Zip | 85747-5828
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Country | US
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Telephone | 520-838-0302
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Fax | 520-838-0982
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Provider Business Mailing Address
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Address Line | 10501 E SEVEN GENERATIONS WAY 155
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City | TUCSON
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State | AZ
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Zip | 85747-5828
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Country | US
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Telephone | 520-838-0302
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Fax | 520-838-0982
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHARLES E PICK
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Credential | D.D.S.
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Telephone | 529-838-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4821
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License Number State | AZ
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