Organization
LAKE POWELL DENTAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY S GIFFORD DMD (OWNER)
(928) 645-2505
Entity
Organization
Contact information
Practice address
436 VISTA AVENUE, BOX 1956, PAGE, AZ 86040
(928) 645-2505
(928) 645-6820
Mailing address
436 VISTA, PAGE, AZ 86040-1956
(928) 645-2505
(928) 645-6820
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2639
AZ
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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