# PDA HOLDCO CHANDLER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kids Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811449671
- **Authorized official:** JERAMY TARWATER (PRESIDENT)
- **Authorized official phone:** (602) 253-6600

## Contact information

- **Practice address:** 2900 W RAY RD STE 2, CHANDLER, AZ 85224-7342
- **Practice address phone:** (480) 782-5437
- **Practice address fax:** (480) 857-7888
- **Mailing address:** 2900 W RAY RD STE 2, CHANDLER, AZ 85224-7342
- **Mailing address phone:** (480) 782-5437
- **Mailing address fax:** (480) 857-7888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 8502 | AZ | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/27/2016
- **Last updated:** 02/07/2023