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General NPI Number Information
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NPI Number | 1316113715
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Entity Type | Organization
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Legal Business Name | TOOTH CASTLE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 2316 W BETHANY HOME RD SUITE 110
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City | PHOENIX
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State | AZ
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Zip | 85015-1850
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Country | US
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Telephone | 602-841-4400
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Fax | 601-841-4404
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Provider Business Mailing Address
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Address Line | PO BOX 45359
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City | PHOENIX
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State | AZ
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Zip | 85064-5359
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Country | US
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Telephone | 602-841-4400
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Fax | 602-841-4404
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA ANGELES FUENTES
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Credential | DDS
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Telephone | 602-841-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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