DHHS PHS IHS Phoenix Area
Organization Active NPI Dentist · Winterhaven, CA
NPI 1649432121 · NPPES record last updated Apr 20, 2018
Key facts
- NPI
- 1649432121
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- DHHS PHS IHS PHOENIX AREA
- Practice address
- 401 Picacho Road
Winterhaven, CA 92283 - Phone
- (760) 572-4100
- Fax
- (760) 572-2133
- NPI assigned
- Jun 26, 2008
- Organization subpart
- No
Authorized official
- Name
- Cindy S Baldwin
- Title
- Chief Executive Office
- Phone
- (760) 572-4100
Corporate family (same tax ID) 3
National Provider Directory
- Tax ID family
- DHHS PHS IHS Phoenix Area
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes | ||
| General Practice Dentistry |
1223G0001X | |||
| Pediatric Dentistry |
1223P0221X | |||
| Periodontics |
1223P0300X | |||
| Dental Hygienist |
124Q00000X |
Addresses
Primary practice location
401 Picacho Road
Winterhaven, CA 92283
Mailing address
PO Box 1368
Yuma, AZ 85366
Phone (760) 572-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020211 | Medicaid | AZ | |
| P0201800 | Other | AZ | BLUE CROSS |
| HSZ078 | Other | MCARE GRP # | |
| 092370 | Medicaid | AZ |
Other names
- Ft Yuma Indian Health Center - Dental
Other providers in Winterhaven, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.