Healthcare Provider Details

I. General information

NPI: 1275077513
Provider Name (Legal Business Name): WESTWINDDENTAL DOWNTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 N 3RD ST
PHOENIX AZ
85012-2015
US

IV. Provider business mailing address

3806 N 3RD ST
PHOENIX AZ
85012-2015
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-1088
  • Fax:
Mailing address:
  • Phone: 602-277-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRISTOPHER KNIGHT
Title or Position: MANGER
Credential:
Phone: 602-269-7797