# DENTAL INNOVATIONS-WINSLOW

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104461268
- **Authorized official:** LAURA VAUGHN (MANAGER)
- **Authorized official phone:** (623) 210-3416

## Contact information

- **Practice address:** 722 MIKE'S PIKE STREET, \#101, WINSLOW, AZ 86047
- **Practice address phone:** (928) 289-3738
- **Mailing address:** 34225 N 27TH DR, BLDG 5 STE 241, PHOENIX, AZ 85085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/13/2019
- **Last updated:** 11/13/2019