Healthcare Provider Details

I. General information

NPI: 1487379426
Provider Name (Legal Business Name): NUSET SCOTTSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 E RAINTREE DR STE 170
SCOTTSDALE AZ
85260-3961
US

IV. Provider business mailing address

7991 VANCE DR STE A
ARVADA CO
80003-2148
US

V. Phone/Fax

Practice location:
  • Phone: 520-503-5700
  • Fax:
Mailing address:
  • Phone: 303-422-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CORY RYAN
Title or Position: OWNER
Credential: MD, DDS
Phone: 303-501-2212