Healthcare Provider Details

I. General information

NPI: 1821138223
Provider Name (Legal Business Name): NORTH MOUNTAIN DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E MARYLAND AVE
PHOENIX AZ
85014-1499
US

IV. Provider business mailing address

1550 E MARYLAND AVE
PHOENIX AZ
85014-1499
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-9979
  • Fax:
Mailing address:
  • Phone: 602-285-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SEYMOUR ROSEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 602-285-9979