Organization
SOUTH TOWN DENTAL CARE, INC.
Active
Other names
Garden Lakes Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TIM J WILDUNG (CEO / TREASURER)
(602) 391-4107
Entity
Organization
Contact information
Practice address
10720 W INDIAN SCHOOL RD STE 55, PHOENIX, AZ 85037-5724
(623) 877-1729
Mailing address
7205 E SOUTHERN AVE STE A-122, MESA, AZ 85209-2790
(602) 391-4107
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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