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General NPI Number Information
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NPI Number | 1073403911
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Entity Type | Organization
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Legal Business Name | COTTONWOOD KIDS DENTAL LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 2180 AZ 89A
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 954-557-7399
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 E ROMA AVE
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City | PHOENIX
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State | AZ
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Zip | 85018-4251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JORDAN JANIS
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Credential | DMD
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Telephone | 954-557-7399
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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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