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General NPI Number Information
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NPI Number | 1417055294
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Entity Type | Organization
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Legal Business Name | SOUTHERN ARIZONA PERIODONTICS PLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5225 E KNIGHT DR STE #401
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City | TUCSON
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-322-9300
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Fax | 520-322-6889
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Provider Business Mailing Address
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Address Line | 5225 E KNIGHT DR STE #401
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City | TUCSON
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-322-9300
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Fax | 520-322-6889
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JACQUELINE GREENWALL
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Credential |
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Telephone | 520-322-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2591
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4087
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License Number State | AZ
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