Organization
CHILDREN'S DENTAL CLINIC OF TUCSON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRUDY WILLIAMS (DIRECTOR, LICENSING & CREDENTIALING)
(615) 750-0342
Entity
Organization
Contact information
Practice address
910 W IRVINGTON RD, #180, TUCSON, AZ 85714-2458
(520) 806-0120
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
736267
—
AZ
Enumeration date
07/27/2006
Last updated
05/17/2010
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