Healthcare Provider Details

I. General information

NPI: 1275602278
Provider Name (Legal Business Name): ANGELA M THURBER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E. CHANDLER RD. 120
PHOENIX AZ
85044
US

IV. Provider business mailing address

16215 S 31ST ST
PHOENIX AZ
85048-7723
US

V. Phone/Fax

Practice location:
  • Phone: 480-785-7600
  • Fax:
Mailing address:
  • Phone: 480-704-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: