| Mykidzdentist Central Phoenix | |
|
1728 W Glendale Ave #305 Phoenix AZ 85021-8860 | |
| (602) 995-7336 | |
| (602) 995-2665 |
| Full Name | Mykidzdentist Central Phoenix |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1728 W Glendale Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Ernest Nehrer (PRESIDENT) |
| Authorized Official Contact | 8312345526 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mykidzdentist Central Phoenix 1728 W Glendale Ave #305 Phoenix AZ 85021-8860 Ph: (602) 995-7336 | Mykidzdentist Central Phoenix 1728 W Glendale Ave #305 Phoenix AZ 85021-8860 Ph: (602) 995-7336 |
| NPI Number | 1316302599 |
|---|---|
| Provider Enumeration Date | 12/15/2015 |
| Last Update Date | 12/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316302599 | NPI | - | NPPES |
| 955781 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8935 (Arizona) | Primary |
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