Provider Demographics
NPI:1396095816
Name:YUMA DENTISTRY 4 KIDS PLLC
Entity type:Organization
Organization Name:YUMA DENTISTRY 4 KIDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-726-6023
Mailing Address - Street 1:2816 S 4TH AVE
Mailing Address - Street 2:STE C&D
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8101
Mailing Address - Country:US
Mailing Address - Phone:928-726-6023
Mailing Address - Fax:928-726-2945
Practice Address - Street 1:2816 S 4TH AVE STE C&D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8101
Practice Address - Country:US
Practice Address - Phone:928-726-6023
Practice Address - Fax:928-726-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD049641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty