Organization
WAUSA VIKING INC
Active
Other names
Thunderbird Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID W BANKS GENERAL OFFICE MGR (SECRETARY FOR THE CORPORATION)
(602) 955-6000
Entity
Organization
Contact information
Practice address
13822 N 35TH DR, STE 1, PHOENIX, AZ 85053-5542
(602) 978-2146
(602) 978-0640
Mailing address
4730 E INDIAN SCHOOL ROAD, PMB 120 243, PHOENIX, AZ 85018-5441
(602) 955-6000
(602) 952-0030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
AZ
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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