Organization
PLAZA FAMILY DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM J WILDUNG (CEO)
(602) 391-4107
Entity
Organization
Contact information
Practice address
9145 W THUNDERBIRD RD STE H105, PEORIA, AZ 85381-4820
(623) 979-7477
Mailing address
7205 E SOUTHERN AVE STE A-122, MESA, AZ 85209-2790
(602) 391-4107
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009244
AZ
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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