Healthcare Provider Details

I. General information

NPI: 1962905067
Provider Name (Legal Business Name): FRANCISCO FELIPE MASCARENAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 N SCOTTSDALE RD STE 220
SCOTTSDALE AZ
85254-6732
US

IV. Provider business mailing address

10758 W COTTONWOOD LN
AVONDALE AZ
85392-4354
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-4727
  • Fax:
Mailing address:
  • Phone: 623-242-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010207
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: