Healthcare Provider Details

I. General information

NPI: 1033139670
Provider Name (Legal Business Name): DAVID P EMBER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DOBSON RD BLDG C - STE 18
CHANDLER AZ
85224-5678
US

IV. Provider business mailing address

4939 W RAY RD STE 4 - BOX 353
CHANDLER AZ
85226-2065
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-6778
  • Fax: 480-820-3606
Mailing address:
  • Phone: 702-336-2332
  • Fax: 480-961-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6377
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier930710
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: