Healthcare Provider Details

I. General information

NPI: 1184018434
Provider Name (Legal Business Name): WESTSIDE ENDODONTIC PROFESSIONALS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE SUITE D104
GLENDALE AZ
85308-8370
US

IV. Provider business mailing address

18555 N 79TH AVE SUITE D104
GLENDALE AZ
85308-8370
US

V. Phone/Fax

Practice location:
  • Phone: 623-939-3313
  • Fax:
Mailing address:
  • Phone: 623-939-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD STEINBRUNNER
Title or Position: DENTIST
Credential:
Phone: 623-939-3314