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Organization

JUST FOR KIDS DENTISTRY BULLHEAD, 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
2580 HWY 95, STE. 101, BULLHEAD CITY, AZ 86442
(928) 758-9464
(928) 758-9459
Mailing address
2580 HWY 95, STE. 101, BULLHEAD CITY, AZ 86442
(928) 758-9464
(928) 758-9459

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
06/27/2008
Last updated
03/06/2014
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