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General NPI Number Information
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NPI Number | 1073202388
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Entity Type | Organization
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Legal Business Name | AZ KIDZ HEALTHY SMILES FOUNDATION
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 16167 W DEVONSHIRE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-7777
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Country | US
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Telephone | 602-684-4965
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Fax |
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Provider Business Mailing Address
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Address Line | 16167 W DEVONSHIRE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-7777
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Country | US
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Telephone | 602-684-4965
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. KATHLEEN M LUISI
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Credential | BSDH, RDH
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Telephone | 617-913-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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