Healthcare Provider Details

I. General information

NPI: 1063679322
Provider Name (Legal Business Name): NICHOLAS ROBERT EINBENDER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S ALAMO AVE
TUCSON AZ
85707-4402
US

IV. Provider business mailing address

4175 S ALAMO AVE
TUCSON AZ
85707-4402
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2778
  • Fax:
Mailing address:
  • Phone: 520-228-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12335275-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: