Provider Demographics
NPI:1922575844
Name:KINGMAN FAMILY DENTISTRY
Entity type:Organization
Organization Name:KINGMAN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-208-7982
Mailing Address - Street 1:34225 N 27TH DRIVE
Mailing Address - Street 2:BLDG 5 SUITE 241
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6091
Mailing Address - Country:US
Mailing Address - Phone:623-439-2280
Mailing Address - Fax:623-289-2578
Practice Address - Street 1:1751 STOCKTON HILL RD
Practice Address - Street 2:STE A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6601
Practice Address - Country:US
Practice Address - Phone:928-718-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty