Organization
GILBERT KIDTASTIC DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
3303 E QUEEN CREEK RD STE 106, GILBERT, AZ 85297-8532
(480) 988-2079
Mailing address
3303 E QUEEN CREEK RD STE 106, GILBERT, AZ 85297-8532
(480) 988-2079
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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