Healthcare Provider Details

I. General information

NPI: 1740021278
Provider Name (Legal Business Name): MARISSA OLMOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8591 E BELL RD
SCOTTSDALE AZ
85260-1305
US

IV. Provider business mailing address

6117 E EDGEMONT AVE
SCOTTSDALE AZ
85257-1050
US

V. Phone/Fax

Practice location:
  • Phone: 480-367-0300
  • Fax:
Mailing address:
  • Phone: 623-824-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012167
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: