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General NPI Number Information
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NPI Number | 1619822194
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Entity Type | Organization
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Legal Business Name | KIDS INTEGRATIVE NORTERRA DENTISTRY, LLC
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 2460 W HAPPY VALLEY RD STE 1189
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City | PHOENIX
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State | AZ
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Zip | 85085-8511
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Country | US
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Telephone | 602-833-2564
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Fax |
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Provider Business Mailing Address
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Address Line | 1934 E CAMELBACK RD STE 110
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City | PHOENIX
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State | AZ
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Zip | 85016-4136
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Country | US
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Telephone | 602-833-2564
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | MR. BEN J HIMMELSTEIN
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Credential | ESQ.
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Telephone | 480-229-7498
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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 |
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License Number State |
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