CHILDREN'S MEDICAID DENTAL CLINIC, PC

PHOENIX, AZ
NPI1326025974
Doing Business AsCHILDREN'S DENTAL CLINIC OF W. THOMAS RD.
Entity TypeOrganization
Authorized ContactTRUDY WILLIAMS
Director, Licensing & Credentialing
615-750-0342
Organization Subpart ?No
Primary Taxonomy1223G0001X Dentist, General Practice
Enumeration Date2005-12-26
Last Update Date2010-05-17
Business Address
CHILDREN'S MEDICAID DENTAL CLINIC, PC
5115 W THOMAS RD
PHOENIX, AZ 85031-3944
Phone number: 602-233-3133
Mailing Address
CHILDREN'S MEDICAID DENTAL CLINIC, PC
201 W 8TH ST SUITE 810
PUEBLO, CO 81003-3038
Phone number: 719-562-4447