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General NPI Number Information
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NPI Number | 1538308358
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Entity Type | Organization
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Legal Business Name | SANTAN DENTAL, PLLC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 1185 N ARIZONA BLVD
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City | COOLIDGE
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State | AZ
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Zip | 85228-3203
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Country | US
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Telephone | 520-723-3801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1640
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-1640
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Country | US
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Telephone | 520-723-3801
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY ELIZABETH TIERNEY
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Credential | RDH
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Telephone | 520-723-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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