# BCKK 83RD AND CAMELBACK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coyote Ridge Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285853671
- **Authorized official:** KI NGO DMD (PRESIDENT OWNER)
- **Authorized official phone:** (480) 917-0181

## Contact information

- **Practice address:** 8141 W CAMELBACK RD, SUITE 3, PHOENIX, AZ 85033-1050
- **Practice address phone:** (623) 848-9100
- **Practice address fax:** (623) 247-3917
- **Mailing address:** 8141 W CAMELBACK RD, SUITE 3, PHOENIX, AZ 85033-1050
- **Mailing address phone:** (623) 848-9100
- **Mailing address fax:** (623) 247-3917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1808900 | UCCI | AZ |