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General NPI Number Information
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NPI Number | 1144683061
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Entity Type | Organization
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Legal Business Name | LITCHFIELD DENTAL CARE
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 14044 W CAMELBACK RD SUITE 106
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9428
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Country | US
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Telephone | 623-547-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 14044 W CAMELBACK RD SUITE 106
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9428
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Country | US
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Telephone | 623-547-0307
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN KIM
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Credential | DDS
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Telephone | 623-547-0307
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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 | D05476
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License Number State | AZ
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