Healthcare Provider Details

I. General information

NPI: 1114183209
Provider Name (Legal Business Name): BRIAN D DEDINSKY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 E VIRGINIA AVE
PHOENIX AZ
85004-1202
US

IV. Provider business mailing address

367 E VIRGINIA AVE
PHOENIX AZ
85004-1202
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-6303
  • Fax: 602-256-6302
Mailing address:
  • Phone: 602-256-6303
  • Fax: 602-256-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAZ20400
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAZ20400
License Number StateAZ

VIII. Authorized Official

Name: DR. BRIAN DAVID DEDINSKY
Title or Position: OWNER
Credential: M.D.
Phone: 602-256-6303