Healthcare Provider Details

I. General information

NPI: 1265344154
Provider Name (Legal Business Name): DENTAL IMPLANT INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 E PINNACLE PEAK RD STE 210
SCOTTSDALE AZ
85255-3728
US

IV. Provider business mailing address

8787 E PINNACLE PEAK RD STE 210
SCOTTSDALE AZ
85255-3728
US

V. Phone/Fax

Practice location:
  • Phone: 623-455-9179
  • Fax: 480-660-5358
Mailing address:
  • Phone: 623-455-9179
  • Fax: 480-660-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI ANDERSON
Title or Position: OWNER/PROVIDER
Credential: DDS
Phone: 623-455-9179