Healthcare Provider Details

I. General information

NPI: 1386719706
Provider Name (Legal Business Name): TONY C KAOCHAROEN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7054 E COCHISE RD B200
SCOTTSDALE AZ
85253-4546
US

IV. Provider business mailing address

7054 E COCHISE RD B200
SCOTTSDALE AZ
85253-4546
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-0498
  • Fax: 480-951-2127
Mailing address:
  • Phone: 480-607-0498
  • Fax: 480-951-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5312
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: