Healthcare Provider Details

I. General information

NPI: 1659308641
Provider Name (Legal Business Name): NORTH VALLEY ENDODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 111
PHOENIX AZ
85022-6639
US

IV. Provider business mailing address

8121 E INDIAN BEND RD STE 128
SCOTTSDALE AZ
85250-4820
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-3800
  • Fax: 602-404-0983
Mailing address:
  • Phone: 26-734-4518
  • Fax: 602-482-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4411
License Number StateAZ

VIII. Authorized Official

Name: DEBORAH HENEBRY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 602-734-4518