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General NPI Number Information
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NPI Number | 1295687077
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Entity Type | Organization
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Legal Business Name | EDOA REM 2 MI LLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2934 W INA RD
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City | TUCSON
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State | AZ
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Zip | 85741-2110
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Country | US
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Telephone | 520-848-0384
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Fax |
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Provider Business Mailing Address
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Address Line | 2934 W INA RD
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City | TUCSON
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State | AZ
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Zip | 85741-2110
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Country | US
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Telephone | 520-848-0384
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES
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Name | SHAYLA MOORE
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Credential |
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Telephone | 402-505-6843
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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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