# KETHCART SLEEP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central Phoenix Center for TMJ, Pain & Sleep Disorders
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235641937
- **Authorized official:** DR. STEPHANIE WAGNER KETHCART DDS (MANAGAING MEMBER/DENTIST)
- **Authorized official phone:** (602) 615-8516

## Contact information

- **Practice address:** 1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
- **Practice address phone:** (602) 615-8516
- **Practice address fax:** (602) 883-7252
- **Mailing address:** 1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
- **Mailing address phone:** (602) 615-8516
- **Mailing address fax:** (602) 883-7252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | D6695 | AZ | — |

## Other

- **Enumeration date:** 11/02/2017
- **Last updated:** 07/13/2020