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General NPI Number Information
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NPI Number | 1003458688
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Entity Type | Organization
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Legal Business Name | UPTOWN PEDIATRIC DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 1515 E MISSOURI AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85014-2443
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Country | US
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Telephone | 602-279-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 7236 N 18TH PL
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City | PHOENIX
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State | AZ
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Zip | 85020-5236
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Country | US
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Telephone | 312-345-5526
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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 | ERNEST NEHRER
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Credential | DDS
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Telephone | 831-234-5526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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