Organization
KETHCART SLEEP LLC
Active
Other names
Central Phoenix Center for TMJ, Pain & Sleep Disorders
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE WAGNER KETHCART DDS (MANAGAING MEMBER/DENTIST)
(602) 615-8516
Entity
Organization
Contact information
Practice address
1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
(602) 615-8516
(602) 883-7252
Mailing address
1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
(602) 615-8516
(602) 883-7252
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
D6695
AZ
Other
Enumeration date
11/02/2017
Last updated
07/13/2020
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