Provider Demographics
NPI:1023432820
Name:CIVANO DENTAL CARE PC
Entity type:Organization
Organization Name:CIVANO DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:529-838-0302
Mailing Address - Street 1:10501 E SEVEN GENERATIONS WAY
Mailing Address - Street 2:155
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5828
Mailing Address - Country:US
Mailing Address - Phone:520-838-0302
Mailing Address - Fax:520-838-0982
Practice Address - Street 1:10501 E SEVEN GENERATIONS WAY
Practice Address - Street 2:155
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5828
Practice Address - Country:US
Practice Address - Phone:520-838-0302
Practice Address - Fax:520-838-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4821261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental