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NPI Code Detail

MEDICARE: TOOTH CLUB FOR KIDS PHOENIX

MEDICARE: TOOTH CLUB FOR KIDS PHOENIX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1053132084
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOOTH CLUB FOR KIDS PHOENIX
Provider Business Mailing Address
First Line : 4901 W BELL RD STE 100
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-3414
Country : US
Telephone Number : 602-843-1275
Fax Number : 602-843-1276
Provider Business Practice Location Address
First Line : 7777 N 43RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-5712
Country : US
Telephone Number : 602-888-7844
Fax Number : 602-843-1276
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. KIMBERLIE APRIL STUBBS
Credential :
Telephone Number : 602-843-1275
Provider Enumeration Date : 10/22/2024
Last Update Date : 10/22/2024

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Directions to “TOOTH CLUB FOR KIDS PHOENIX ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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