Organization Name: | FLORENCE DENTAL PLLC |
NPI Number: | 1003061250 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON WHETTEN (OWNER/DENTIST) |
Mailing Address: | 46 E 11th St Florence |
State: | AZ US |
Postal Code: | 85232 |
Phone Number: | 5208683384 |
Fax Number: | |
NPI Enumeration Date: | 12/01/2008 |
NPI Last Update Date: | 12/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D7646 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |