Healthcare Provider Details

I. General information

NPI: 1295918928
Provider Name (Legal Business Name): JAMES WAYNE JENISTA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10715 N FRANK LLOYD WRIGHT BLVD, STE 102
SCOTTSDALE AZ
85259
US

IV. Provider business mailing address

10715 N FRANK LLOYD WRIGHT BLVD, STE 102
SCOTTSDALE AZ
85259
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6000
  • Fax: 480-657-3203
Mailing address:
  • Phone: 480-860-6000
  • Fax: 480-657-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4540
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: