=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770265407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLSIDE DENTAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2023
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7241 N THORNYDALE RD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85741-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-744-0700
-----------------------------------------------------
Fax | 877-581-5499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7241 N THORNYDALE RD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85741-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-744-0700
-----------------------------------------------------
Fax | 877-581-5499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/OWNER
-----------------------------------------------------
Name | FRANK W WOLF
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 773-251-1734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------