Healthcare Provider Details

I. General information

NPI: 1477709004
Provider Name (Legal Business Name): KEVIN BRIAN CEBRYNSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE DR STE 240
SCOTTSDALE AZ
85260-6277
US

IV. Provider business mailing address

9097 E DESERT COVE DR STE 240
SCOTTSDALE AZ
85260-6277
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-6541
  • Fax:
Mailing address:
  • Phone: 480-661-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4475
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: