Healthcare Provider Details

I. General information

NPI: 1477133890
Provider Name (Legal Business Name): ERIN NICOLE SCHWOEGL DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 210
PHOENIX AZ
85050-4268
US

IV. Provider business mailing address

20950 N TATUM BLVD STE 210
PHOENIX AZ
85050-4268
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD012245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: