Organization
DHHS IHS PHOENIX AREA
Active
Parent organization
DHHS IHS PHOENIX AREA
Other names
Whiteriver Service Unit Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHHS IHS PHOENIX AREA
Authorized official
MICHELLE MARTINEZ FNP (CHIEF EXECUTIVE OFFICER)
(928) 338-4911
Entity
Organization
Contact information
Practice address
200 WEST HOSPITAL WAY, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Mailing address
PO BOX 860, 200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020561
—
AZ
05
—
092403-01
—
AZ
01
—
AZ0109760
BC DENTAL
AZ
Enumeration date
03/23/2007
Last updated
12/27/2011
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