Organization
ARIZONA DEPARTMENT OF HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES H HUMBLE (CHIEF FINANCIAL OFFICER)
(602) 364-0679
Entity
Organization
Contact information
Practice address
150 N 18TH AVENUE, SUITE 320, PHOENIX, AZ 85007-3205
(602) 542-1866
(602) 364-1494
Mailing address
150 N 18TH AVENUE, SUITE 320, PHOENIX, AZ 85007-3205
(602) 542-1866
(602) 364-1494
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703886
—
AZ
Enumeration date
08/30/2013
Last updated
08/30/2013
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