Healthcare Provider Details

I. General information

NPI: 1750138038
Provider Name (Legal Business Name): TATIANA MCBRIDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15260 W MCDOWELL RD
GOODYEAR AZ
85395-2530
US

IV. Provider business mailing address

15260 W MCDOWELL RD
GOODYEAR AZ
85395-2530
US

V. Phone/Fax

Practice location:
  • Phone: 623-207-7867
  • Fax:
Mailing address:
  • Phone: 623-207-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD012785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: