Provider Demographics
NPI:1265195614
Name:DOCS ARIZONA, P.C.
Entity type:Organization
Organization Name:DOCS ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-362-5938
Mailing Address - Street 1:1221 VINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4829
Mailing Address - Country:US
Mailing Address - Phone:813-451-4503
Mailing Address - Fax:
Practice Address - Street 1:5405 E GRANITE ST BLDG 2527
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-3004
Practice Address - Country:US
Practice Address - Phone:267-927-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCS ARIZONA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD010291OtherLC LIC#