Provider Demographics
NPI:1053132084
Name:TOOTH CLUB FOR KIDS PHOENIX
Entity type:Organization
Organization Name:TOOTH CLUB FOR KIDS PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLIE
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-843-1275
Mailing Address - Street 1:4901 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3414
Mailing Address - Country:US
Mailing Address - Phone:602-843-1275
Mailing Address - Fax:602-843-1276
Practice Address - Street 1:7777 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5712
Practice Address - Country:US
Practice Address - Phone:602-888-7844
Practice Address - Fax:602-843-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental