Healthcare Provider Details

I. General information

NPI: 1225131493
Provider Name (Legal Business Name): WILLIAM K TADANO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 N 19TH AVE 101
PHOENIX AZ
85021
US

IV. Provider business mailing address

7550 N 19TH AVE 101
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 602-864-0004
  • Fax: 602-864-0070
Mailing address:
  • Phone: 602-864-0004
  • Fax: 602-864-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2020
License Number StateAZ

VIII. Authorized Official

Name: DR. WILLIAM K TADANO
Title or Position: OWNER
Credential: DDS
Phone: 602-864-0004