Healthcare Provider Details

I. General information

NPI: 1013942689
Provider Name (Legal Business Name): PRIME TIME DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 N MILLER RD SUITE 1
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

3226 N MILLER RD SUITE 1
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 480-421-0113
  • Fax: 480-421-0115
Mailing address:
  • Phone: 480-421-0113
  • Fax: 480-421-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AILEEN L RICHARDSON
Title or Position: PRESIDENT
Credential: RDH
Phone: 480-421-0113