Organization Name: | TRICITY DENTAL |
NPI Number: | 1043471493 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL JUAN WULFF (OWNER) |
Mailing Address: | 1000 Willow Creek Rd Suite H Prescott |
State: | AZ US |
Postal Code: | 863011645 |
Phone Number: | 9284453181 |
Fax Number: | 9284455797 |
NPI Enumeration Date: | 06/18/2008 |
NPI Last Update Date: | 06/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D3674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |