# WAUSA VIKING INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thunderbird Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649331786
- **Authorized official:** MR. DAVID W BANKS GENERAL OFFICE MGR (SECRETARY FOR THE CORPORATION)
- **Authorized official phone:** (602) 955-6000

## Contact information

- **Practice address:** 13822 N 35TH DR, STE 1, PHOENIX, AZ 85053-5542
- **Practice address phone:** (602) 978-2146
- **Practice address fax:** (602) 978-0640
- **Mailing address:** 4730 E INDIAN SCHOOL ROAD, PMB 120 243, PHOENIX, AZ 85018-5441
- **Mailing address phone:** (602) 955-6000
- **Mailing address fax:** (602) 952-0030

## Taxonomy

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

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 08/22/2020