Organization
HOME ANCILLARY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH C KUCERA (EXECUTIVE DIRECTOR)
(303) 526-7739
Entity
Organization
Contact information
Practice address
2942 N 24TH ST STE 114-538, PHOENIX, AZ 85016-7844
(303) 650-5800
Mailing address
2942 N 24TH ST STE 114-538, PHOENIX, AZ 85016-7844
(303) 650-5800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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