Organization
KKTZ DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLE JENNINGS (OFFICE MANAGER)
(928) 577-2533
Entity
Organization
Contact information
Practice address
2277 SWANSON AVE STE E, LAKE HAVASU CITY, AZ 86403-5991
(928) 680-6222
Mailing address
2277 SWANSON AVE STE E, LAKE HAVASU CITY, AZ 86403-5991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/06/2022
Last updated
05/06/2022
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