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Organization

CEDAR AVE FAMILY DENTISTRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN CHITTENDEN DMD (OWNER)
(425) 870-3325
Entity
Organization

Contact information

Practice address
2010 E CEDAR AVE, FLAGSTAFF, AZ 86004-1621
(928) 774-3851
Mailing address
2010 E CEDAR AVE, FLAGSTAFF, AZ 86004-1621
(425) 870-3325

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1528551603
ARIZONA
AZ
01
1538783360
ARIZONA
AZ
Enumeration date
09/26/2024
Last updated
10/08/2024
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