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General NPI Number Information
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NPI Number | 1912038076
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Entity Type | Organization
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Legal Business Name | MARICOPA FAMILY DENTISTRY & ORTHODONTICS
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 44480 WEST HONEYCUTT ROAD SUITE 110
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City | MARICOPA
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State | AZ
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Zip | 85239-2909
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Country | US
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Telephone | 520-568-9100
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Fax | 520-568-9190
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Provider Business Mailing Address
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Address Line | 44480 WEST HONEYCUTT ROAD SUITE 110
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City | MARICOPA
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State | AZ
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Zip | 85239-2909
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Country | US
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Telephone | 520-568-9100
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Fax | 520-568-9190
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED POPE
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Credential | DDS
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Telephone | 520-568-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5769
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5625
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License Number State | AZ
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