| Children's Dental Clinic Of W. Thomas Rd. | |
|
5115 W Thomas Rd Phoenix AZ 85031-3944 | |
| (602) 233-3133 | |
| (602) 278-3139 |
| Full Name | Children's Dental Clinic Of W. Thomas Rd. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5115 W Thomas Rd, Phoenix, Arizona |
| Authorized Official Name and Position | Trudy Williams (DIRECTOR, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500342 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Dental Clinic Of W. Thomas Rd. 201 W 8th St Suite 810 Pueblo CO 81003-3038 Ph: (719) 562-4447 | Children's Dental Clinic Of W. Thomas Rd. 5115 W Thomas Rd Phoenix AZ 85031-3944 Ph: (602) 233-3133 |
| NPI Number | 1326025974 |
|---|---|
| Provider Enumeration Date | 12/26/2005 |
| Last Update Date | 05/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326025974 | NPI | - | NPPES |
| 619661 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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