Healthcare Provider Details

I. General information

NPI: 1255294344
Provider Name (Legal Business Name): GENERATIONAL DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S POWER RD STE 131
MESA AZ
85209-6689
US

IV. Provider business mailing address

2500 S POWER RD STE 131
MESA AZ
85209-6689
US

V. Phone/Fax

Practice location:
  • Phone: 480-504-6516
  • Fax:
Mailing address:
  • Phone: 480-504-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT JOSEPHSON
Title or Position: MEMBER
Credential: DMD
Phone: 480-250-8861