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Organization

JUST FOR KIDS DENTISTRY KINGMAN PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RONALD ANTHONY DICARLO II DMD (PRESIDENT OWNER)
(928) 718-7188
Entity
Organization

Contact information

Practice address
2401 STOCKTON HILL RD, STE 1, KINGMAN, AZ 86401-4189
(928) 718-7188
(928) 718-7189
Mailing address
2401 STOCKTON HILL RD, STE 1, KINGMAN, AZ 86401
(928) 718-7188
(928) 718-7189

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
D6061
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
983470
AZ
Enumeration date
07/07/2008
Last updated
07/07/2008
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