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General NPI Number Information
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NPI Number | 1275687790
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Entity Type | Organization
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Legal Business Name | SOCIETY OF ST. VINCENT DE PAUL
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 W WATKINS RD
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City | PHOENIX
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State | AZ
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Zip | 85003-2830
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Country | US
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Telephone | 602-261-6874
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Fax | 602-261-6816
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Provider Business Mailing Address
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Address Line | 420 W WATKINS RD
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City | PHOENIX
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State | AZ
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Zip | 85003-2830
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Country | US
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Telephone | 602-261-6874
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Fax | 602-261-6816
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Authorized Official
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Title or Position | DENTAL CLINIC DIRECTOR
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Name | DR. FLOYD KENNETH SNYDER
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Credential | DMD
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Telephone | 602-261-6825
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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 | AZ2056
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License Number State | AZ
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