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General NPI Number Information
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NPI Number | 1023535002
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Entity Type | Organization
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Legal Business Name | BOOTH ORTHODONTICS PLLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10 N ALAMOS DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4072
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Country | US
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Telephone | 928-634-2121
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Fax | 928-634-4141
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Provider Business Mailing Address
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Address Line | 10 N ALAMOS DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4072
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Country | US
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Telephone | 928-634-2121
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Fax | 928-634-4141
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS PAUL BOOTH
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Credential | DMD, MS
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Telephone | 928-634-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D009378
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License Number State | AZ
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