Provider Demographics
NPI:1194059931
Name:KIDS DENTAL , P.C.
Entity type:Organization
Organization Name:KIDS DENTAL , P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-956-2024
Mailing Address - Street 1:9515 W CAMELBACK RD
Mailing Address - Street 2:#140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1355
Mailing Address - Country:US
Mailing Address - Phone:623-872-2662
Mailing Address - Fax:602-956-2209
Practice Address - Street 1:9515 W CAMELBACK RD
Practice Address - Street 2:#140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1355
Practice Address - Country:US
Practice Address - Phone:623-872-2662
Practice Address - Fax:602-956-2209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS DENTAL PLACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty