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General NPI Number Information
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NPI Number | 1093397507
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Entity Type | Organization
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Legal Business Name | THE WIGGLY TOOTH PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 10401 E MCDOWELL MOUNTAIN RANCH RD STE 130
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7525
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Country | US
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Telephone | 480-358-7224
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Fax |
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Provider Business Mailing Address
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Address Line | 29211 N 23RD DR
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City | PHOENIX
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State | AZ
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Zip | 85085-2753
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Country | US
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Telephone | 480-358-7224
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | NAJMEH SHAHBAZI
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Credential | DMD
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Telephone | 480-358-7224
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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 |
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License Number State |
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