Healthcare Provider Details

I. General information

NPI: 1508253014
Provider Name (Legal Business Name): BENJAMIN NOEL ZUNIGA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 W CAMELBACK RD
PHOENIX AZ
85019
US

IV. Provider business mailing address

33 N LINDSAY RD STE 101
GILBERT AZ
85234-5808
US

V. Phone/Fax

Practice location:
  • Phone: 602-427-4070
  • Fax:
Mailing address:
  • Phone: 805-539-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD010402
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: