Provider Demographics
NPI:1790907004
Name:GENERAL DENTISTRY 4 KIDS-TUCSON, PLLC
Entity type:Organization
Organization Name:GENERAL DENTISTRY 4 KIDS-TUCSON, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-866-8811
Mailing Address - Street 1:2102 N COUNTRY CLUB RD STE A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2831
Mailing Address - Country:US
Mailing Address - Phone:520-323-1400
Mailing Address - Fax:
Practice Address - Street 1:2102 N COUNTRY CLUB RD STE A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2831
Practice Address - Country:US
Practice Address - Phone:520-323-1400
Practice Address - Fax:520-547-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty