Provider Demographics
NPI:1144345026
Name:ARIZONA DENTURE CLINIC INC
Entity type:Organization
Organization Name:ARIZONA DENTURE CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-788-4040
Mailing Address - Street 1:3010 E CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7113
Mailing Address - Country:US
Mailing Address - Phone:602-788-4040
Mailing Address - Fax:602-788-4044
Practice Address - Street 1:3010 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7113
Practice Address - Country:US
Practice Address - Phone:602-788-4040
Practice Address - Fax:602-788-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty