# CORE FAMILY DENTAL

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

## Provider details

- **NPI number:** 1689283814
- **Authorized official:** MARVIN BLANE JACKSON DDS (OWNER)
- **Authorized official phone:** (435) 637-2100

## Contact information

- **Practice address:** 13460 N 94TH DR STE K4, PEORIA, AZ 85381-4249
- **Practice address phone:** (232) 231-0366
- **Mailing address:** 13460 N 94TH DR STE K4, PEORIA, AZ 85381-4249
- **Mailing address phone:** (232) 231-0366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/23/2020
- **Last updated:** 07/28/2020