Healthcare Provider Details

I. General information

NPI: 1154256121
Provider Name (Legal Business Name): IAN JACOB ALTOBELLI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 E MARY ANN CLEVELAND WAY
VAIL AZ
85641-8613
US

IV. Provider business mailing address

13410 E MARY ANN CLEVELAND WAY
VAIL AZ
85641-8613
US

V. Phone/Fax

Practice location:
  • Phone: 520-316-0613
  • Fax:
Mailing address:
  • Phone: 520-316-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: