# HOME ANCILLARY SERVICES

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

## Provider details

- **NPI number:** 1659641306
- **Authorized official:** MR. KENNETH C KUCERA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (303) 526-7739

## Contact information

- **Practice address:** 2942 N 24TH ST STE 114-538, PHOENIX, AZ 85016-7844
- **Practice address phone:** (303) 650-5800
- **Mailing address:** 2942 N 24TH ST STE 114-538, PHOENIX, AZ 85016-7844
- **Mailing address phone:** (303) 650-5800

## Taxonomy

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

## Other

- **Enumeration date:** 01/11/2012
- **Last updated:** 01/11/2012