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General NPI Number Information
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NPI Number | 1376056267
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Entity Type | Organization
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Legal Business Name | PHILIP C MOOBERRY DDS PC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 1757 N SWAN RD
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City | TUCSON
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State | AZ
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Zip | 85712-3501
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Country | US
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Telephone | 520-795-7733
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Fax | 520-326-3820
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Provider Business Mailing Address
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Address Line | 1757 N SWAN RD
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City | TUCSON
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State | AZ
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Zip | 85712-3501
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Country | US
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Telephone | 520-795-7733
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Fax | 520-326-3820
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP C MOOBERRY
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Credential | DDS
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Telephone | 520-795-7733
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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 | 3776
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License Number State | AZ
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