Organization
BCKK 83RD AND CAMELBACK LLC
Active
Other names
Coyote Ridge Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
KI NGO DMD (PRESIDENT OWNER)
(480) 917-0181
Entity
Organization
Contact information
Practice address
8141 W CAMELBACK RD, SUITE 3, PHOENIX, AZ 85033-1050
(623) 848-9100
(623) 247-3917
Mailing address
8141 W CAMELBACK RD, SUITE 3, PHOENIX, AZ 85033-1050
(623) 848-9100
(623) 247-3917
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1808900
UCCI
AZ
Enumeration date
04/24/2007
Last updated
08/22/2020
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