Kktz

NPI #1861908857 in Fort Mohave, Arizona

Provider Information

NPI Number: 1861908857
Entity Type: Organization
Organization Name: Kktz
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 28, 2017
Last Updated: Dec 28, 2017

Practice Location

Address: 5221 HWY 95 STE 4
City: Fort Mohave
State: Arizona
ZIP Code: 86426-9244
Phone: (928) 577-2533

Authorized Official

Name: DR. THADD JENNINGS, DDS
Title: MEMBER
Phone: (928) 201-5588

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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Organizations

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