| Katsur Dental Of Arizona | |
|
105 N Litchfield Rd Goodyear AZ 85338-1617 | |
| (623) 932-3200 | |
| (623) 932-3222 |
| Full Name | Katsur Dental Of Arizona |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 105 N Litchfield Rd, Goodyear, Arizona |
| Authorized Official Name and Position | Terri Gardiner (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 4077725124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Katsur Dental Of Arizona 926 Great Pond Dr Suite 5000 Altamonte Springs FL 32714-7244 Ph: (407) 772-5124 | Katsur Dental Of Arizona 105 N Litchfield Rd Goodyear AZ 85338-1617 Ph: (623) 932-3200 |
| NPI Number | 1174771612 |
|---|---|
| Provider Enumeration Date | 09/08/2008 |
| Last Update Date | 11/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174771612 | NPI | - | NPPES |
| 565806 | Other | AZ | SANTORO AHCCCS# |
| 294311 | Other | AZ | LOAN KIM DAO AHCCCS# |
| 197645 | Other | AZ | ONET AHCCCS# |
| 506058 | Other | AZ | TURNER AHCCCS# |
| 368780 | Other | AZ | GROUP AHCCCS# |
| 561921 | Other | AZ | WHATCOTT AHCCCS# |
| 774457 | Other | AZ | SKAALEN AHCCCS# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5795 (Arizona) | Secondary |
| 1223G0001X | Dentist - General Practice | 5216 (Arizona) | Primary |
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