Healthcare Provider Details

I. General information

NPI: 1063561553
Provider Name (Legal Business Name): DIANA A. BATOON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 N SCOTTSDALE RD SUITE # 130
SCOTTSDALE AZ
85254-6734
US

IV. Provider business mailing address

11111 N SCOTTSDALE RD STE 130
SCOTTSDALE AZ
85254-6734
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-0643
  • Fax:
Mailing address:
  • Phone: 480-776-0643
  • Fax: 480-776-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4819
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4819
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4819
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: