Healthcare Provider Details

I. General information

NPI: 1649159518
Provider Name (Legal Business Name): EAST BELL ROAD DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8591 E BELL RD STE 101
SCOTTSDALE AZ
85260-1305
US

IV. Provider business mailing address

8591 E BELL RD STE 101
SCOTTSDALE AZ
85260-1305
US

V. Phone/Fax

Practice location:
  • Phone: 480-367-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JENNY GARCIA
Title or Position: SR. CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789