Organization
KATSUR DENTAL OF ARIZONA, INC.
Active
Other names
Katsur Dental of Arizona
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI GARDINER (CREDENTIALING COORDINATOR)
(407) 772-5124
Entity
Organization
Contact information
Practice address
105 N LITCHFIELD RD, GOODYEAR, AZ 85338-1617
(623) 932-3200
(623) 932-3222
Mailing address
926 GREAT POND DR, SUITE 5000, ALTAMONTE SPRINGS, FL 32714-7244
(407) 772-5124
(407) 788-3572
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5216
AZ
1223G0001X
General Practice Dentistry
5795
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197645
ONET AHCCCS#
AZ
01
—
294311
LOAN KIM DAO AHCCCS#
AZ
01
—
368780
GROUP AHCCCS#
AZ
01
—
506058
TURNER AHCCCS#
AZ
01
—
561921
WHATCOTT AHCCCS#
AZ
01
—
565806
SANTORO AHCCCS#
AZ
01
—
774457
SKAALEN AHCCCS#
AZ
Enumeration date
09/08/2008
Last updated
11/12/2010
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