Healthcare Provider Details

I. General information

NPI: 1831882018
Provider Name (Legal Business Name): WEST VALLEY SPECIALTIES GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 E OSBORN RD
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

14150 W MCDOWELL RD
GOODYEAR AZ
85395
US

V. Phone/Fax

Practice location:
  • Phone: 480-687-3951
  • Fax: 480-687-9616
Mailing address:
  • Phone: 623-536-2040
  • Fax: 623-536-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GEORGE R AYOUB
Title or Position: PRESIDENT
Credential: DDS
Phone: 623-536-2040