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General NPI Number Information
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NPI Number | 1588932651
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Entity Type | Organization
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Legal Business Name | TUCSON SMILES PEDIATRIC DENTISTRY AT RITA RANCH
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 8265 S HOUGHTON RD SUITE 131
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City | TUCSON
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State | AZ
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Zip | 85747-5765
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Country | US
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Telephone | 520-664-9000
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Fax | 520-664-2090
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Provider Business Mailing Address
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Address Line | 8265 S HOUGHTON RD SUITE 131
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City | TUCSON
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State | AZ
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Zip | 85747-5765
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Country | US
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Telephone | 520-664-9000
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Fax | 520-664-2090
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Authorized Official
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Title or Position | PRACTICE COORDINATOR
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Name | MS. ANGELA BETANCOURT
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Credential |
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Telephone | 520-664-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5679
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License Number State | AZ
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