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General NPI Number Information
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NPI Number | 1073982997
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Entity Type | Organization
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Legal Business Name | EAST SCOTTSDALE PEDIATRIC DENTAL, PC
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 12020 E SHEA BLVD STE 8
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-4179
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Country | US
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Telephone | 480-767-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 12020 E SHEA BLVD STE 8
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-4179
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Country | US
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Telephone | 480-767-5600
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CANDACE H VENEBERG
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Credential | D.D.S
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Telephone | 501-850-5110
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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 | D009209
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License Number State | AZ
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