Healthcare Provider Details

I. General information

NPI: 1316883291
Provider Name (Legal Business Name): JANBOU DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE B130
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

11209 N TATUM BLVD STE B130
PHOENIX AZ
85028-3091
US

V. Phone/Fax

Practice location:
  • Phone: 480-400-3364
  • Fax: 480-400-3573
Mailing address:
  • Phone: 480-400-3364
  • Fax: 480-400-3573

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. MATTHEW JANBOU
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 480-400-3364