Healthcare Provider Details

I. General information

NPI: 1174769582
Provider Name (Legal Business Name): ROSEMARY SPACEK RDH AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 E OSBORN RD
SCOTTSDALE AZ
85251-6026
US

IV. Provider business mailing address

PO BOX 6182
GLENDALE AZ
85312-6182
US

V. Phone/Fax

Practice location:
  • Phone: 480-312-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH560
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: