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General NPI Number Information
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NPI Number | 1053132084
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Entity Type | Organization
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Legal Business Name | TOOTH CLUB FOR KIDS PHOENIX
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 7777 N 43RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-5712
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Country | US
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Telephone | 602-888-7844
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Fax | 602-843-1276
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Provider Business Mailing Address
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Address Line | 4901 W BELL RD STE 100
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City | GLENDALE
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State | AZ
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Zip | 85308-3414
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Country | US
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Telephone | 602-843-1275
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Fax | 602-843-1276
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KIMBERLIE APRIL STUBBS
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Credential |
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Telephone | 602-843-1275
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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 |
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License Number State |
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