Healthcare Provider Details

I. General information

NPI: 1174148985
Provider Name (Legal Business Name): NOAH VACANTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 N SCOTTSDALE RD STE 140
SCOTTSDALE AZ
85254-5270
US

IV. Provider business mailing address

11000 N SCOTTSDALE RD STE 140
SCOTTSDALE AZ
85254-5270
US

V. Phone/Fax

Practice location:
  • Phone: 480-596-8273
  • Fax:
Mailing address:
  • Phone: 480-596-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010665
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: