Healthcare Provider Details

I. General information

NPI: 1922371186
Provider Name (Legal Business Name): NEDRA POINDEXTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E CHANDLER BLVD STE 120
PHOENIX AZ
85048-0868
US

IV. Provider business mailing address

4910 E CHANDLER BLVD STE 120
PHOENIX AZ
85048-0868
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: