Healthcare Provider Details

I. General information

NPI: 1528975547
Provider Name (Legal Business Name): ARIZONA DENTAL PROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 W GLENDALE AVE STE 30
PHOENIX AZ
85051-8322
US

IV. Provider business mailing address

5151 N 16TH ST APT 4009
PHOENIX AZ
85016-3816
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-0550
  • Fax:
Mailing address:
  • Phone: 916-833-6359
  • Fax: 916-833-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN TULLY
Title or Position: OWNER
Credential: DMD
Phone: 916-833-6359