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General NPI Number Information
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NPI Number | 1033587985
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Entity Type | Organization
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Legal Business Name | HD TUCSON DENTAL LLC
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 5577 N ORACLE RD SUITE 101
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City | TUCSON
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State | AZ
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Zip | 85704-3877
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Country | US
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Telephone | 520-777-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 5577 N ORACLE RD SUITE 101
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City | TUCSON
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State | AZ
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Zip | 85704-3877
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Country | US
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Telephone | 520-777-0616
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Fax |
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Authorized Official
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Title or Position | VP OF PRACTICE START UP
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Name | MR. PERRY TODD MYERS
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Credential |
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Telephone | 435-714-6555
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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 |
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License Number State |
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