Healthcare Provider Details

I. General information

NPI: 1275681330
Provider Name (Legal Business Name): CARL J. GASSMANN MD, DDS.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 N HAYDEN RD SUITE H-112
SCOTTSDALE AZ
85260-5518
US

IV. Provider business mailing address

10603 N HAYDEN RD SUITE H-112
SCOTTSDALE AZ
85260-5518
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-9933
  • Fax: 480-607-9120
Mailing address:
  • Phone: 480-922-9933
  • Fax: 480-607-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD4868
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number23387
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: