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General NPI Number Information
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NPI Number | 1922796226
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Entity Type | Organization
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Legal Business Name | TKO DENTISTRY
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 8573 E PRINCESS DR # B-201
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7819
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Country | US
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Telephone | 509-969-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 7845 W FETLOCK TRL
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City | PEORIA
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State | AZ
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Zip | 85383-6296
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Country | US
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Telephone | 509-969-0889
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MARIA WYTKO
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Credential | DMD
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Telephone | 509-969-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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