Dr Wisdom Teeth
Clinic/Center, Dental in San Tan Valley, AZ. Organization (NPI-2).
NPI number1992298533
StatusActive
Last updated in NPPESJun 8, 2018
Details
- NPI
- 1992298533
- Entity type
- Organization (NPI-2)
- Legal business name
- Dr Wisdom Teeth
- Organization subpart
- No
- Enumeration date
- Jun 8, 2018
- Last updated
- Jun 8, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | D009399 | AZ | Yes |
Other names
- Dr Wisdom Teeth (Doing Business As)
Practice location
287 E Hunt Hwy Ste 101San Tan Valley, AZ 85143-5096
Phone 833-394-7366
Mailing address
287 E Hunt Hwy Ste 101San Tan Valley, AZ 85143-5096
Phone 833-394-7366
Authorized official
Jeffrey Fenn
Owner
7023257627
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