RUSTIC MOUNTAIN DENTISTRY NPI 1063983245

NPI Information

NPI: 1063983245
Provider Name: RUSTIC MOUNTAIN DENTISTRY
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
606 N MAIN STREET
TAYLOR, AZ
ZIP 85939
Phone: (928) 457-0758
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RUSTIC MOUNTAIN DENTISTRY is a dental clinic center in Taylor, AZ. RUSTIC MOUNTAIN DENTISTRY NPI is 1063983245. The provider is registered as an organization entity type.

The provider's business location address is:

606 N MAIN STREET
TAYLOR, AZ
ZIP 85939-593
Phone: (928) 457-0758
Fax: (928) 457-0821

The provider's authorized official is Kenneth Houston Davis .
The authorized official title is Doctor/owner and has the following contact phone number (928) 457-0758.

The enumeration date for this NPI number is 12/16/2018 and was last updated on 12/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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