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General NPI Number Information
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NPI Number | 1255043444
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Entity Type | Organization
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Legal Business Name | AZ FAMILY AND KIDS DENTAL TEMPE LLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 825 W BASELINE RD STE 6
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City | TEMPE
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State | AZ
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Zip | 85283-5371
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Country | US
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Telephone | 480-777-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 825 W BASELINE RD STE 6
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City | TEMPE
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State | AZ
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Zip | 85283-5371
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Country | US
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Telephone | 480-777-5570
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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. RICHARD PARKER SMITH
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Credential | DDS
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Telephone | 480-777-5570
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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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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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