Healthcare Provider Details

I. General information

NPI: 1225368798
Provider Name (Legal Business Name): MICHAEL S. CAVENDER, DDS, PSC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD #337
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

9377 E BELL RD #337
SCOTTSDALE AZ
85260-1502
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-8118
  • Fax: 480-342-8131
Mailing address:
  • Phone: 480-342-8118
  • Fax: 480-342-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6872
License Number StateAZ

VIII. Authorized Official

Name: MICHAEL STEPHEN CAVENDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 480-342-8118