Provider Demographics
NPI:1528675303
Name:FOOTHILLS FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:FOOTHILLS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-695-4192
Mailing Address - Street 1:16627 S LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1501
Mailing Address - Country:US
Mailing Address - Phone:602-695-4192
Mailing Address - Fax:
Practice Address - Street 1:7229 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2097
Practice Address - Country:US
Practice Address - Phone:520-744-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty