Organization
DHEW INDIAN HEALTH SERVICE HEALTH SERVICES & MENTAL HEALTH ADM.
Active
Other names
Gila Bend Clinic Dental Services
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DEANNA J. DICK MSW., MHA. ((CEO) CHIEF EXECUTIVE OFFICER)
(602) 263-1567
Entity
Organization
Contact information
Practice address
100 NORTH GILA BOULEVARD, GILA BEND, AZ 85227-2658
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0001X
Public Health Dentistry
—
—
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812851
—
AZ
Enumeration date
01/26/2007
Last updated
06/19/2019
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