Organization
MAIN STREET PRACTICE LLC
Active
Other names
Canyon Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE MCLEOD (CEO)
(520) 290-6181
Entity
Organization
Contact information
Practice address
2837 W NORTHERN AVE, PHOENIX, AZ 85051-6646
(602) 995-2419
Mailing address
11550 E IRVINGTON RD, TUCSON, AZ 85747-8925
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/18/2007
Last updated
08/22/2020
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