Provider Demographics
NPI:1316111057
Name:GENERAL DENTISTRY FOR KIDS-GREENWAY PLLC
Entity type:Organization
Organization Name:GENERAL DENTISTRY FOR KIDS-GREENWAY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TANN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:480-607-9999
Mailing Address - Street 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-607-9999
Mailing Address - Fax:
Practice Address - Street 1:3202 E GREENWAY RD
Practice Address - Street 2:STE 1287
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4548
Practice Address - Country:US
Practice Address - Phone:602-996-6065
Practice Address - Fax:602-996-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty