Healthcare Provider Details

I. General information

NPI: 1407854722
Provider Name (Legal Business Name): MICHAEL A. MARKSON, D.M.D., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10802 N 71ST PL
SCOTTSDALE AZ
85254-5204
US

IV. Provider business mailing address

10802 N 71ST PL
SCOTTSDALE AZ
85254-5204
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-1144
  • Fax: 480-998-1565
Mailing address:
  • Phone: 480-991-1144
  • Fax: 480-998-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2290
License Number StateAZ

VIII. Authorized Official

Name: MICHAEL A. MARKSON
Title or Position: OWNER
Credential: D.M.D.
Phone: 480-991-1144