| 1915 Dental Pllc | |
|
2221 E Frontage Rd C-101 Tubac AZ 85646 | |
| (520) 398-8408 | |
| Not Available |
| Full Name | 1915 Dental Pllc |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 2221 E Frontage Rd, Tubac, Arizona |
| Authorized Official Name and Position | Alex Foor (OWNER/DENTIST) |
| Authorized Official Contact | 5203988408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1915 Dental Pllc Po Box 4562 Tubac AZ 85646-4562 Ph: (520) 398-8408 | 1915 Dental Pllc 2221 E Frontage Rd C-101 Tubac AZ 85646 Ph: (520) 398-8408 |
| NPI Number | 1639643059 |
|---|---|
| Provider Enumeration Date | 01/18/2019 |
| Last Update Date | 12/11/2024 |
| Medicare PECOS PAC ID | 0143755744 |
|---|---|
| Medicare Enrollment ID | O20241119003745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639643059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Primary |