Healthcare Provider Details

I. General information

NPI: 1568650877
Provider Name (Legal Business Name): ROGER A BRIGGS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 E SHEA BLVD SUITE 201
SCOTTSDALE AZ
85254-6180
US

IV. Provider business mailing address

6920 E SHEA BLVD STE 201
SCOTTSDALE AZ
85254-7100
US

V. Phone/Fax

Practice location:
  • Phone: 480-948-7670
  • Fax: 480-991-7168
Mailing address:
  • Phone: 480-699-1017
  • Fax: 480-991-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1872
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD01872
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD01872
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD01872
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: