Healthcare Provider Details

I. General information

NPI: 1043350432
Provider Name (Legal Business Name): NORTH MOUNTAIN DENTAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N MILLER RD STE 135
SCOTTSDALE AZ
85251-6431
US

IV. Provider business mailing address

3301 N MILLER RD STE 135
SCOTTSDALE AZ
85251-6431
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-0277
  • Fax:
Mailing address:
  • Phone: 480-949-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. SEYMOUR ROSEN
Title or Position: SECRETARY
Credential: DDS
Phone: 480-949-0277