# ANASAZI DENTURE CLINIC, LLC

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

## Provider details

- **NPI number:** 1962733600
- **Authorized official:** CARMEN CAIN CDT, LD, DN (PRESIDENT)
- **Authorized official phone:** (480) 471-9560

## Contact information

- **Practice address:** 18425 E STIRRUP LN, RIO VERDE, AZ 85263-7114
- **Practice address phone:** (480) 471-9560
- **Mailing address:** P.O.BOX 111, DAYTON, WA 99328
- **Mailing address phone:** (480) 650-4234
- **Mailing address fax:** (480) 471-3089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DN60082396 | WA | Yes |
| 302F00000X | Exclusive Provider Organization | DN60082396 | WA | — |

## Other

- **Enumeration date:** 01/20/2010
- **Last updated:** 01/20/2010