# DHHS PHS IHS PHOENIX AREA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ft Yuma Indian Health Center - Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649432121
- **Authorized official:** CINDY S BALDWIN (CHIEF EXECUTIVE OFFICE)
- **Authorized official phone:** (760) 572-4100

## Contact information

- **Practice address:** 401 PICACHO ROAD, WINTERHAVEN, CA 92283
- **Practice address phone:** (760) 572-4100
- **Practice address fax:** (760) 572-2133
- **Mailing address:** PO BOX 1368, YUMA, AZ 85366
- **Mailing address phone:** (760) 572-4100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | — | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 06/26/2008
- **Last updated:** 04/20/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 020211 | — | AZ |
| 05 | — | 092370 | — | AZ |
| 01 | — | HSZ078 | MCARE GRP \# | — |
| 01 | — | P0201800 | BLUE CROSS | AZ |