Organization
DENTAL INNOVATIONS-WINSLOW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA VAUGHN (MANAGER)
(623) 210-3416
Entity
Organization
Contact information
Practice address
722 MIKE'S PIKE STREET, #101, WINSLOW, AZ 86047
(928) 289-3738
Mailing address
34225 N 27TH DR, BLDG 5 STE 241, PHOENIX, AZ 85085
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
11/13/2019
Last updated
11/13/2019
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