Healthcare Provider Details

I. General information

NPI: 1174062095
Provider Name (Legal Business Name): JOSHUA JAMES HEYREND D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 S MILL AVE STE 105
TEMPE AZ
85282-3688
US

IV. Provider business mailing address

3244 S MILL AVE STE 105
TEMPE AZ
85282-3688
US

V. Phone/Fax

Practice location:
  • Phone: 480-355-4131
  • Fax:
Mailing address:
  • Phone: 480-355-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010686
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4918
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: