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General NPI Number Information
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NPI Number | 1568182368
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Entity Type | Individual
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Provider Name | KELSEY FOCHT DMD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 1646 N LITCHFIELD RD STE 125
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City | GOODYEAR
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State | AZ
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Zip | 85395-1273
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Country | US
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Telephone | 623-935-2755
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Fax |
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Provider Business Mailing Address
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Address Line | 6634 W MONONA DR
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City | GLENDALE
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State | AZ
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Zip | 85308-6656
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Country | US
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Telephone | 509-699-0336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D011473
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License Number State | AZ
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