Provider Demographics
NPI:1710001797
Name:MICHAEL J KILLEBREW DDS & ASSOCIATES PLLC
Entity type:Organization
Organization Name:MICHAEL J KILLEBREW DDS & ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KILLEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-401-4191
Mailing Address - Street 1:8753 E HONEYBEAR PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8202
Mailing Address - Country:US
Mailing Address - Phone:520-401-4191
Mailing Address - Fax:520-760-0859
Practice Address - Street 1:63675 E SADDLEBROOKE BLVD
Practice Address - Street 2:STE. M
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1297
Practice Address - Country:US
Practice Address - Phone:520-818-6732
Practice Address - Fax:520-818-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2339261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental