# WOW DENTAL AZ, PLLC

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

## Provider details

- **NPI number:** 1740190917
- **Authorized official:** MARIANNE TILTON (PROVIDER ENROLLMENT SUPERVISOR)
- **Authorized official phone:** (315) 454-6000

## Contact information

- **Practice address:** 3650 FRONTAGE RD, BULLHEAD CITY, AZ 86442-8154
- **Practice address phone:** (928) 704-0220
- **Mailing address:** PO BOX 70887, CLEVELAND, OH 44190-0887

## Taxonomy

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

## Other

- **Enumeration date:** 09/10/2026
- **Last updated:** 09/10/2026