Provider Demographics
NPI:1063602605
Name:JUST FOR KIDS GENERAL DENTISTRY, PC
Entity type:Organization
Organization Name:JUST FOR KIDS GENERAL DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DICARLO
Authorized Official - Suffix:II
Authorized Official - Credentials:D,M,D
Authorized Official - Phone:928-718-7188
Mailing Address - Street 1:2401 STOCKTON HILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4189
Mailing Address - Country:US
Mailing Address - Phone:928-718-7188
Mailing Address - Fax:928-718-7189
Practice Address - Street 1:1111 RIATA VALLEY RD
Practice Address - Street 2:STE 300
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3678
Practice Address - Country:US
Practice Address - Phone:928-692-9315
Practice Address - Fax:928-692-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty