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General NPI Number Information
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NPI Number | 1740673268
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Entity Type | Organization
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Legal Business Name | SOUTHWEST KIDS DENTISTRY PLLC
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 6970 N ORACLE RD SUITE 110
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City | TUCSON
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State | AZ
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Zip | 85704-4237
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Country | US
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Telephone | 520-775-1245
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Fax | 520-775-1246
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Provider Business Mailing Address
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Address Line | PO BOX 35308
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City | TUCSON
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State | AZ
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Zip | 85740-5308
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Country | US
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Telephone | 541-961-2618
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLA HOLLEN
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Credential | DMD
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Telephone | 520-775-1245
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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 | D008688
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License Number State | AZ
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