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General NPI Number Information
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NPI Number | 1366133597
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Entity Type | Organization
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Legal Business Name | KIDS DENTAL SPOT PLLC
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1601 E BELL RD STE A13
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City | PHOENIX
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State | AZ
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Zip | 85022-6254
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Country | US
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Telephone | 480-863-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E BELL RD STE A13
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City | PHOENIX
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State | AZ
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Zip | 85022-6254
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DAVID JOURABCHI
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Credential | DDS
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Telephone | 480-863-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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