Healthcare Provider Details

I. General information

NPI: 1811552128
Provider Name (Legal Business Name): PAYSON DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13825 N NORTHSIGHT BLVD STE 120
SCOTTSDALE AZ
85260-3684
US

IV. Provider business mailing address

315 E ST HWY 260
PAYSON AZ
85541-4930
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-8400
  • Fax:
Mailing address:
  • Phone: 928-474-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MULLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-474-2200