Provider Demographics
NPI:1023179900
Name:CENTRAL DENTISTRY
Entity type:Organization
Organization Name:CENTRAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLUFF
Authorized Official - Suffix:
Authorized Official - Credentials:RDH AZ LIC NO H4143
Authorized Official - Phone:928-428-2750
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85548
Mailing Address - Country:US
Mailing Address - Phone:928-428-2750
Mailing Address - Fax:928-428-9460
Practice Address - Street 1:1807 THATCHER BLVD
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:928-428-2750
Practice Address - Fax:928-428-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD15021223G0001X
AZ42231223G0001X
AZ36041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty