Organization
PDA HOLDINGS WEST, LLC
Active
Other names
Magic Smiles Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
JERAMY TARWATER (PRESIDENT)
(602) 253-6600
Entity
Organization
Contact information
Practice address
5109 W THOMAS RD STE 300, PHOENIX, AZ 85031-3944
(602) 472-3553
(602) 687-9844
Mailing address
5109 W THOMAS RD STE 300, PHOENIX, AZ 85031-3944
(602) 472-3553
(602) 687-9844
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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