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General NPI Number Information
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NPI Number | 1306310867
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Entity Type | Organization
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Legal Business Name | THE GOOD DENTIST LLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 821 W WICKENBURG WAY
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City | WICKENBURG
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State | AZ
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Zip | 85390-4263
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Country | US
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Telephone | 928-684-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 821 W WICKENBURG WAY
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City | WICKENBURG
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State | AZ
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Zip | 85390-4263
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Country | US
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Telephone | 623-302-0220
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MIRANDA JONES
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Credential |
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Telephone | 623-302-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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