Healthcare Provider Details

I. General information

NPI: 1083819148
Provider Name (Legal Business Name): NORTH SCOTTSDALE CHILDREN'S DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9360 E RAINTREE DR STE 107
SCOTTSDALE AZ
85260-2099
US

IV. Provider business mailing address

9360 E RAINTREE DR STE 107
SCOTTSDALE AZ
85260-2099
US

V. Phone/Fax

Practice location:
  • Phone: 480-515-9599
  • Fax: 480-515-9799
Mailing address:
  • Phone: 480-515-9599
  • Fax: 480-515-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6143
License Number StateAZ

VIII. Authorized Official

Name: SCOTT WEXLER
Title or Position: DENTIST
Credential: DMD
Phone: 480-515-9599