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Organization
KATSUR DENTAL OF ARIZONA, INC.
Active
Organization
KATSUR DENTAL OF ARIZONA, INC.
Active
Other names
Katsur Dental of Arizona
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI GARDINER (CREDENTIALING COORDINATOR)
(407) 772-5124
Entity
Organization
Contact information
Practice address
105 N LITCHFIELD RD, GOODYEAR, AZ 85338-1617
(623) 932-3200
(623) 932-3222
Mailing address
926 GREAT POND DR, SUITE 5000, ALTAMONTE SPRINGS, FL 32714-7244
(407) 772-5124
(407) 788-3572
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5216
AZ
1223G0001X
General Practice Dentistry
5795
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197645
ONET AHCCCS#
AZ
01
—
294311
LOAN KIM DAO AHCCCS#
AZ
01
—
368780
GROUP AHCCCS#
AZ
01
—
506058
TURNER AHCCCS#
AZ
01
—
561921
WHATCOTT AHCCCS#
AZ
01
—
565806
SANTORO AHCCCS#
AZ
01
—
774457
SKAALEN AHCCCS#
AZ
Enumeration date
09/08/2008
Last updated
11/12/2010
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