Provider Demographics
NPI:1033504469
Name:SUPERIOR FAMILY DENTAL CARE
Entity type:Organization
Organization Name:SUPERIOR FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-689-2191
Mailing Address - Street 1:230 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85173-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:AZ
Practice Address - Zip Code:85173-2638
Practice Address - Country:US
Practice Address - Phone:520-689-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD061611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty