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Organization
DHHS PHS IHS PHOENIX AREA
Active
Organization
DHHS PHS IHS PHOENIX AREA
Active
Other names
Ft Yuma Indian Health Center - Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY S BALDWIN (CHIEF EXECUTIVE OFFICE)
(760) 572-4100
Entity
Organization
Contact information
Practice address
401 PICACHO ROAD, WINTERHAVEN, CA 92283
(760) 572-4100
(760) 572-2133
Mailing address
PO BOX 1368, YUMA, AZ 85366
(760) 572-4100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020211
—
AZ
05
—
092370
—
AZ
01
—
HSZ078
MCARE GRP #
—
01
—
P0201800
BLUE CROSS
AZ
Enumeration date
06/26/2008
Last updated
04/20/2018
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