Healthcare Provider Details

I. General information

NPI: 1407390826
Provider Name (Legal Business Name): WESTWINDDENTAL UNIONHILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W UNION HILLS DR
PHOENIX AZ
85027-5580
US

IV. Provider business mailing address

717 W UNION HILLS DR
PHOENIX AZ
85027-5580
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-0753
  • Fax:
Mailing address:
  • Phone: 602-863-0753
  • 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