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Organization

GORDON K. ROEDIGER, D.D.S., EASTSIDE, P.C.

Active
Other names
Acacia Family Dental Group
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GORDON KENT ROEDIGER D.D.S. (PRESIDENT/OWNER)
(520) 795-3773
Entity
Organization

Contact information

Practice address
5190 E FARNESS DR STE 100, TUCSON, AZ 85712-2142
(520) 795-3773
(520) 795-4008
Mailing address
5190 E FARNESS DR STE 100, TUCSON, AZ 85712-2142
(520) 795-3773
(520) 795-4008

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2385
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1093925232
NPI
AZ
01
1457543613
NPI
AZ
01
1669532057
NPI
AZ
Enumeration date
12/20/2007
Last updated
12/20/2007
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