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General NPI Number Information
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NPI Number | 1003224619
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL SPECIALTY GROUP LLC
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Dates
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Enumeration Date | 07/27/2014
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 7600 E CAMELBACK RD SUITE 8
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2106
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Country | US
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Telephone | 480-282-6746
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Fax | 602-610-4737
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Provider Business Mailing Address
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Address Line | 7600 E CAMELBACK RD SUITE 8
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2106
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Country | US
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Telephone | 480-282-6746
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | VERONICA M MARTINEZ
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Credential | DDS
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Telephone | 480-282-6746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D008464
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D8006
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License Number State | AZ
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