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General NPI Number Information
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NPI Number | 1477767010
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Entity Type | Organization
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Legal Business Name | SAN TAM DENTAL CARE & MOBILE CLINIC PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22240 S ELLSWORTH RD SUITE 102
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City | QUEEN CREEK
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State | AZ
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Zip | 85242
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Country | US
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Telephone | 480-987-9220
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Fax | 480-987-0502
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Provider Business Mailing Address
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Address Line | 22240 S ELLSWORTH RD SUITE 102
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City | QUEEN CREEK
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State | AZ
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Zip | 85242
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Country | US
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Telephone | 480-987-9220
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Fax | 480-987-0502
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. CHRISTINE LYNN DIMERO CLAVERIA
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Credential | DMD
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Telephone | 480-987-9220
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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 | 3335
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License Number State | AZ
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