Provider Demographics
NPI:1255117636
Name:KIDS DENTIST TUCSON PLLC
Entity type:Organization
Organization Name:KIDS DENTIST TUCSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-370-3365
Mailing Address - Street 1:4625 N ORACLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1639
Mailing Address - Country:US
Mailing Address - Phone:520-333-3488
Mailing Address - Fax:520-214-2345
Practice Address - Street 1:4625 N ORACLE RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1639
Practice Address - Country:US
Practice Address - Phone:520-333-3488
Practice Address - Fax:520-214-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty