Healthcare Provider Details

I. General information

NPI: 1639152184
Provider Name (Legal Business Name): NEAL JARED NATION D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 N 19TH AVE
PHOENIX AZ
85015-1127
US

IV. Provider business mailing address

23956 N 74TH ST
SCOTTSDALE AZ
85255-3420
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-5741
  • Fax: 602-242-5742
Mailing address:
  • Phone: 480-664-2175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6299
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: