Office Receiving Referral
Name
Associated Dental Care Providers-Ina
Address
3773 W Ina Rd Ste 180 Tucson, AZ 85741
Email
ADCPIna@mydentalmail.com
Office Phone
520-579-8166
Office Sending Referral
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No Insurance
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Guardian's Phone
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Primary Insurance Company
Primary Subscriber Name
Primary Subscriber Date of Birth
Primary Member ID
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Secondary Subscriber Name
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