Organization
JUST FOR KIDS DENTISTRY BULLHEAD, PLLC
Active
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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