Provider Demographics
NPI:1053144576
Name:TOOTH CLUB FOR KIDS PCH PLLC
Entity type:Organization
Organization Name:TOOTH CLUB FOR KIDS PCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLIE
Authorized Official - Middle Name:
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:602-843-1275
Practice Address - Street 1:1701 E THOMAS RD STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7675
Practice Address - Country:US
Practice Address - Phone:602-253-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental