# SOUTH FRONTAGE ROAD DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gila Ridge Dental -Foothills
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497402465
- **Authorized official:** VICENTA REYES (CREDENTIALING LEAD)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 11259 S FRONTAGE RD STE 103, YUMA, AZ 85367-7883
- **Practice address phone:** (928) 342-7351
- **Mailing address:** 11259 S FRONTAGE RD STE 103, YUMA, AZ 85367-7883
- **Mailing address phone:** (928) 342-7351

## Taxonomy

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

## Other

- **Enumeration date:** 03/09/2022
- **Last updated:** 03/09/2022