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General NPI Number Information
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NPI Number | 1538593157
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Entity Type | Organization
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Legal Business Name | ARIZONA DEPARTMENT OF HEALTH SERVICES
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 150 N 18TH AVENUE, SUITE 320
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City | PHOENIX
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State | AZ
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Zip | 85007-3205
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Country | US
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Telephone | 602-542-1866
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Fax | 602-364-1494
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Provider Business Mailing Address
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Address Line | 150 N 18TH AVENUE, SUITE 320
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City | PHOENIX
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State | AZ
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Zip | 85007-3205
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Country | US
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Telephone | 602-542-1866
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Fax | 602-364-1494
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JAMES H HUMBLE
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Credential |
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Telephone | 602-364-0679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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