Organization
PDA HOLDCO CHANDLER LLC
Active
Other names
Kids Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
JERAMY TARWATER (PRESIDENT)
(602) 253-6600
Entity
Organization
Contact information
Practice address
2900 W RAY RD STE 2, CHANDLER, AZ 85224-7342
(480) 782-5437
(480) 857-7888
Mailing address
2900 W RAY RD STE 2, CHANDLER, AZ 85224-7342
(480) 782-5437
(480) 857-7888
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8502
AZ
1223P0221X
Pediatric Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226988
—
AZ
Enumeration date
10/27/2016
Last updated
02/07/2023
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