Healthcare Provider Details

I. General information

NPI: 1639636020
Provider Name (Legal Business Name): AZ DENTIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 E VIA LINDA STE 226
SCOTTSDALE AZ
85258-5345
US

IV. Provider business mailing address

10245 E VIA LINDA STE 226
SCOTTSDALE AZ
85258-5345
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-2188
  • Fax:
Mailing address:
  • Phone: 480-630-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANNE LYNCH
Title or Position: OWNER
Credential: DDS
Phone: 602-303-5827