Healthcare Provider Details

I. General information

NPI: 1396500476
Provider Name (Legal Business Name): DYSON DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E WHITEHOUSE CANYON RD STE 100
GREEN VALLEY AZ
85614-0542
US

IV. Provider business mailing address

2222 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2830
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-0800
  • Fax: 520-625-1680
Mailing address:
  • Phone: 520-838-0777
  • Fax: 520-838-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WHITE
Title or Position: PRACTICE ADMIN
Credential:
Phone: 520-838-0777