Healthcare Provider Details

I. General information

NPI: 1598509796
Provider Name (Legal Business Name): SCOTTSDALE PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 W SOUTHERN AVE STE 18
MESA AZ
85202-4853
US

IV. Provider business mailing address

4731 E UNION HILLS DR STE 108
PHOENIX AZ
85050-3319
US

V. Phone/Fax

Practice location:
  • Phone: 480-645-9988
  • Fax:
Mailing address:
  • Phone: 480-565-6755
  • Fax: 602-396-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA BUKHARI
Title or Position: OWNER
Credential: DDS
Phone: 480-645-9988