Provider Demographics
NPI:1902268261
Name:ICHIBA MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ICHIBA MANAGEMENT, LLC
Other - Org Name:MERCADO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BILLING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TEENAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-687-9430
Mailing Address - Street 1:10135 E VIA LINDA
Mailing Address - Street 2:SUITE C-119
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5328
Mailing Address - Country:US
Mailing Address - Phone:480-661-6633
Mailing Address - Fax:
Practice Address - Street 1:10135 E VIA LINDA
Practice Address - Street 2:SUITE C-119
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5328
Practice Address - Country:US
Practice Address - Phone:480-661-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental