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General NPI Number Information
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NPI Number | 1750551842
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Entity Type | Organization
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Legal Business Name | MICHAEL J. KILLEBREW DENTISTRY PLLC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 3121 S. HIGHWAY 83 SUITE D
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City | SONOITA
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State | AZ
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Zip | 85637
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Country | US
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Telephone | 520-455-5280
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Fax | 520-455-5474
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | SONOITA
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State | AZ
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Zip | 85637-0158
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Country | US
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Telephone | 520-455-5280
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Fax | 520-455-5474
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J. KILLEBREW
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Credential | D.D.S.
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Telephone | 520-455-5280
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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 |
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License Number State |
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