Healthcare Provider Details

I. General information

NPI: 1689895765
Provider Name (Legal Business Name): RIDGE DENTAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD SUITE 210
PHOENIX AZ
85050
US

IV. Provider business mailing address

20950 N TATUM BLVD SUITE 210
PHOENIX AZ
85050
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-8100
  • Fax: 480-538-8101
Mailing address:
  • Phone: 480-538-8100
  • Fax: 480-538-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD6278
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD6932
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD6338
License Number StateAZ

VIII. Authorized Official

Name: THOMAS PAUL LAMMOT
Title or Position: PRESIDENT ENDODONTIST
Credential: DDS
Phone: 480-538-8100