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General NPI Number Information
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NPI Number | 1063383115
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Entity Type | Organization
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Legal Business Name | GREAT DENTISTRY PLLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 430 W FINNIE FLAT RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7362
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Country | US
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Telephone | 928-567-3799
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Fax |
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Provider Business Mailing Address
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Address Line | 6496 E BROMBIL ST
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-3837
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Country | US
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Telephone | 602-323-6862
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | EDGARDO NICOLAS TIMPANARO
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Credential | DMD
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Telephone | 602-323-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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