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General NPI Number Information
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NPI Number | 1144347501
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Entity Type | Organization
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Legal Business Name | DHHS IHS PHOENIX AREA
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 200 WEST HOSPITAL WAY
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City | WHITERIVER
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State | AZ
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Zip | 85941-0860
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Country | US
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Telephone | 928-338-4911
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Fax | 928-338-5508
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Provider Business Mailing Address
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Address Line | PO BOX 860 200 WEST HOSPITAL DRIVE
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City | WHITERIVER
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State | AZ
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Zip | 85941-0860
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Country | US
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Telephone | 928-338-4911
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Fax | 928-338-5508
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MICHELLE MARTINEZ
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Credential | FNP
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Telephone | 928-338-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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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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