Healthcare Provider Details

I. General information

NPI: 1942408232
Provider Name (Legal Business Name): WILLIAM MELVIN TUDOR RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

8310 E SAN SALVADOR DR
SCOTTSDALE AZ
85258-1835
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1511
  • Fax:
Mailing address:
  • Phone: 480-368-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5216
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number562
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: