Provider Demographics
NPI:1316113715
Name:TOOTH CASTLE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:TOOTH CASTLE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA ANGELES
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-841-4400
Mailing Address - Street 1:PO BOX 45359
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-5359
Mailing Address - Country:US
Mailing Address - Phone:602-841-4400
Mailing Address - Fax:602-841-4404
Practice Address - Street 1:2316 W BETHANY HOME RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1850
Practice Address - Country:US
Practice Address - Phone:602-841-4400
Practice Address - Fax:601-841-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty