Healthcare Provider Details

I. General information

NPI: 1780893511
Provider Name (Legal Business Name): ALAN NEAL SEDELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE STE D410
GLENDALE AZ
85308-5006
US

IV. Provider business mailing address

7421 W SADDLEHORN RD
PEORIA AZ
85383-7365
US

V. Phone/Fax

Practice location:
  • Phone: 623-292-7284
  • Fax:
Mailing address:
  • Phone: 973-879-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number045273
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD010825
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: