Healthcare Provider Details

I. General information

NPI: 1235722331
Provider Name (Legal Business Name): MICHAEL G. NADAULD, DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 W GLENDALE AVE STE 102
PHOENIX AZ
85021-8576
US

IV. Provider business mailing address

1526 W GLENDALE AVE STE 102
PHOENIX AZ
85021-8576
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-7279
  • Fax:
Mailing address:
  • Phone: 602-995-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL G NADAULD
Title or Position: OWNER
Credential: DMD
Phone: 801-641-0565