Organization
DHHS-PHS, IHS TUCSON AREA, IHS TUCSON
Active
Other names
SAN XAVIER CLINIC DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ARLENE RAYMOND (BUDGET ANALYST)
(520) 295-2427
Entity
Organization
Contact information
Practice address
7900 S J STOCK RD, TUCSON, AZ 85746-7012
(520) 295-2575
(520) 295-2574
Mailing address
7900 S J STOCK RD, TUCSON, AZ 85746-7012
(520) 295-2503
(520) 295-2676
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004101-03
—
AZ
01
—
0325678
NACADP#
AZ
01
—
03D0864297
CLIA #
AZ
01
—
AZ0209600
BC/BSAZ DENTAL PROV NO
AZ
Enumeration date
11/22/2005
Last updated
04/22/2008
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