MEDICARE: DR. DAN NYDEGGER D.D.S.

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
1	122300000X	Dentist	5540	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	619645	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1275663791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN NYDEGGER D.D.S.

Provider Business Mailing Address
First Line	:	5664 W BELL RD STE 102
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3868
Country	:	US
Telephone Number	:	602-978-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5664 W BELL RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3868
Country	:	US
Telephone Number	:	602-978-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	01/03/2025

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