Healthcare Provider Details

I. General information

NPI: 1912265158
Provider Name (Legal Business Name): DENTAL FACIAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7054 E COCHISE RD STE B105
SCOTTSDALE AZ
85253-4551
US

IV. Provider business mailing address

7054 E COCHISE RD STE B105
SCOTTSDALE AZ
85253-4551
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-3833
  • Fax: 480-945-0498
Mailing address:
  • Phone: 480-945-3833
  • Fax: 480-945-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number7-D-3233
License Number StateAZ

VIII. Authorized Official

Name: DAVID J HENRY
Title or Position: OWNER
Credential: DDS
Phone: 480-945-3833