Healthcare Provider Details

I. General information

NPI: 1821607060
Provider Name (Legal Business Name): AM APNEA AND TMJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 N. 44THST. SUITE 14-1008
PHOENIX AZ
85008
US

IV. Provider business mailing address

2303 N. 44THST. SUITE 14-1008
PHOENIX AZ
85008
US

V. Phone/Fax

Practice location:
  • Phone: 602-300-2384
  • Fax:
Mailing address:
  • Phone: 602-300-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA MARIE ANDERSON
Title or Position: OWNER
Credential: DMD
Phone: 602-300-2384