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NPI Code Detail

MEDICARE: DR. SCOTT L. VAN DA HUVEL

MEDICARE: DR. SCOTT L. VAN DA HUVEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2745AZ

General Provider Information

NPI Number : 1083696934
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT L. VAN DA HUVEL
Provider Business Mailing Address
First Line : PO BOX 5177
Second Line :
City : PHOENIX
State : AZ
Zip : 85010-5177
Country : US
Telephone Number : 602-344-5651
Fax Number :
Provider Business Practice Location Address
First Line : 2601 E ROOSEVELT ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4973
Country : US
Telephone Number : 602-344-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/08/2007

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Directions to “ DR. SCOTT L. VAN DA HUVEL ” Practice Location

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