Healthcare Provider Details

I. General information

NPI: 1720423908
Provider Name (Legal Business Name): ACACIA ENDODONTICS AT AHWATUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST STE 136
PHOENIX AZ
85044-9138
US

IV. Provider business mailing address

15215 S 48TH ST STE 136
PHOENIX AZ
85044-9138
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-8550
  • Fax: 480-704-0199
Mailing address:
  • Phone: 480-704-8550
  • Fax: 480-704-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINA ARIEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 480-777-9938