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NPI Code Detail

MEDICARE: FAMILY TOOTH DOCTOR LL, LLC

MEDICARE: FAMILY TOOTH DOCTOR LL, LLC
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
11223G0001XGeneral Practice DentistryD4215AZ

General Provider Information

NPI Number : 1487792594
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY TOOTH DOCTOR LL, LLC
Provider Business Mailing Address
First Line : 4435 E BROADWAY RD
Second Line : SUITE 9
City : MESA
State : AZ
Zip : 85206-2012
Country : US
Telephone Number : 480-223-0255
Fax Number : 480-654-0705
Provider Business Practice Location Address
First Line : 4435 E BROADWAY RD
Second Line : SUITE 9
City : MESA
State : AZ
Zip : 85206-2012
Country : US
Telephone Number : 480-223-0255
Fax Number : 480-654-0705
Authorized Official
Title or Position : OWNER
Name : JAMES FRANK KING
Credential :
Telephone Number : 480-223-0255
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/24/2007

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Directions to “FAMILY TOOTH DOCTOR LL, LLC ” Practice Location

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