| Stan Kidtastic Dental Llc | |
|
2510 E Hunt Hwy Ste 29 San Tan Valley AZ 85143-5208 | |
| (480) 457-4693 | |
| Not Available |
| Full Name | Stan Kidtastic Dental Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2510 E Hunt Hwy Ste 29, San Tan Valley, Arizona |
| Authorized Official Name and Position | Faith Gaskins (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stan Kidtastic Dental Llc 2510 E Hunt Hwy Ste 29 San Tan Valley AZ 85143-5208 Ph: (480) 457-4693 | Stan Kidtastic Dental Llc 2510 E Hunt Hwy Ste 29 San Tan Valley AZ 85143-5208 Ph: (480) 457-4693 |
| NPI Number | 1558902247 |
|---|---|
| Provider Enumeration Date | 10/03/2019 |
| Last Update Date | 10/03/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558902247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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