Healthcare Provider Details

I. General information

NPI: 1912528720
Provider Name (Legal Business Name): RICHARD MCCOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N SCOTTSDALE RD
SCOTTSDALE AZ
85257
US

IV. Provider business mailing address

8485 E MCDONALD DR STE 500
SCOTTSDALE AZ
85250-6335
US

V. Phone/Fax

Practice location:
  • Phone: 480-755-1155
  • Fax:
Mailing address:
  • Phone: 480-755-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: