Provider Demographics
NPI:1154596187
Name:JACK A BUHROW DDS MS PC
Entity type:Organization
Organization Name:JACK A BUHROW DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUHROW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-957-0332
Mailing Address - Street 1:4202 N 32ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4746
Mailing Address - Country:US
Mailing Address - Phone:602-957-0332
Mailing Address - Fax:602-957-3282
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:602-957-0332
Practice Address - Fax:602-957-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCJASMedicare PIN