# TRI-STATES DENTAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649460221
- **Authorized official:** DOMINIC DO D.D.S. (CFO)
- **Authorized official phone:** (928) 704-0144

## Contact information

- **Practice address:** 1518 SIERRA VISTA DR, BULLHEAD CITY, AZ 86442-6069
- **Practice address phone:** (928) 704-0144
- **Practice address fax:** (928) 704-9791
- **Mailing address:** 1518 SIERRA VISTA DR, BULLHEAD CITY, AZ 86442-6069
- **Mailing address phone:** (928) 704-0144
- **Mailing address fax:** (928) 704-9791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4817 | NV | Yes |

## Other

- **Enumeration date:** 07/30/2007
- **Last updated:** 07/30/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 190343 | — | AZ |