Provider Demographics
NPI:1427440270
Name:AUSTROCYLINDROPUNTIA, LLC
Entity type:Organization
Organization Name:AUSTROCYLINDROPUNTIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANPHERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-914-4272
Mailing Address - Street 1:PO BOX 61025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082
Mailing Address - Country:US
Mailing Address - Phone:602-957-3803
Mailing Address - Fax:602-957-3830
Practice Address - Street 1:4235 N 32ND STREET
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85082
Practice Address - Country:US
Practice Address - Phone:602-957-3808
Practice Address - Fax:602-957-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty