Provider Demographics
NPI:1154540367
Name:DENTISTRY FOR CHILDREN PLLC
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-610-6544
Mailing Address - Street 1:1245 E SOUTHERN AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5137
Mailing Address - Country:US
Mailing Address - Phone:480-610-6544
Mailing Address - Fax:480-633-0670
Practice Address - Street 1:1245 E SOUTHERN AVE
Practice Address - Street 2:STE 12
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5137
Practice Address - Country:US
Practice Address - Phone:480-610-6544
Practice Address - Fax:480-633-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5678122300000X
AZ55891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty