Healthcare Provider Details

I. General information

NPI: 1619073814
Provider Name (Legal Business Name): CANDACE H VENEBERG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE H KANN DDS

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 E SHEA BLVD SUITE 8
SCOTTSDALE AZ
85259-4179
US

IV. Provider business mailing address

12020 E SHEA BLVD SUITE 8
SCOTTSDALE AZ
85259-4179
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-5600
  • Fax:
Mailing address:
  • Phone: 480-767-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3792
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number73
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9209
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: