Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Active
Parent organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Other names
YAHC Dental Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Authorized official
LAURA A TILLMAN (CMO)
(602) 263-1674
Entity
Organization
Contact information
Practice address
2121 WEST RESERVATION LOOP ROAD, CAMP VERDE, AZ 86322-8412
(602) 263-1200
(602) 263-1618
Mailing address
PO BOX 95460, CLEVELAND, OH 44101-0033
(602) 581-6088
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812869
—
AZ
Enumeration date
01/24/2007
Last updated
05/26/2021
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