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General NPI Number Information
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NPI Number | 1558274118
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Entity Type | Organization
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Legal Business Name | TONTO BASIN DENTAL CLINIC LLC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 186 E STEPHENS WAY
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City | TONTO BASIN
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State | AZ
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Zip | 85553-0239
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Country | US
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Telephone | 928-479-3055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776
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City | TONTO BASIN
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State | AZ
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Zip | 85553-0776
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Country | US
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Telephone | 928-479-3055
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | NICOLE DENISE MORGAN
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Credential | RDH
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Telephone | 928-701-0389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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