Healthcare Provider Details

I. General information

NPI: 1417869967
Provider Name (Legal Business Name): HIM SPECIALTY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15128 W BELL RD STE 12
SURPRISE AZ
85374-2451
US

IV. Provider business mailing address

9813 N 180TH AVE
WADDELL AZ
85355-4102
US

V. Phone/Fax

Practice location:
  • Phone: 623-698-4494
  • Fax:
Mailing address:
  • Phone: 623-698-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. IBIFURO EARLEY
Title or Position: MEMBER
Credential: DDS
Phone: 623-698-4494