Organization
JUST FOR KIDS DENTISTRY LAKE HAVASU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD A DICARLO II DMD (OWNER)
(928) 718-7188
Entity
Organization
Contact information
Practice address
80 ACOMA BLVD S, SUITE 102, LAKE HAVASU CITY, AZ 86403-6925
(928) 855-7717
(928) 855-7718
Mailing address
80 ACOMA BLVD S, SUITE 102, LAKE HAVASU CITY, AZ 86403-6925
(928) 855-7717
(928) 855-7718
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6061
AZ
Other
Enumeration date
11/18/2008
Last updated
11/18/2008
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