Healthcare Provider Details

I. General information

NPI: 1942410741
Provider Name (Legal Business Name): TUSCANO DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/08/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 N. 75TH AVE,
PHOENIX AZ
85033
US

IV. Provider business mailing address

4017 N. 75TH AVE,
PHOENIX AZ
85033
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-9334
  • Fax: 623-474-2876
Mailing address:
  • Phone: 623-907-9334
  • Fax: 623-474-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5995
License Number StateAZ

VIII. Authorized Official

Name: DR. PETER PHUOC NGUYEN
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 623-907-9334