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General NPI Number Information
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NPI Number | 1114194651
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Entity Type | Organization
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Legal Business Name | DESERT CANYON DENTISTRY PLLC
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 13910 N FRANK LLOYD WRIGHT BLVD STE 3
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-661-1200
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Fax | 480-661-1729
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Provider Business Mailing Address
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Address Line | 13910 N FRANK LLOYD WRIGHT BLVD STE 3
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-661-1200
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Fax | 480-661-1729
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | JOE DALE DITTERLINE
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Credential | DMD
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Telephone | 480-661-1200
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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 | D4395
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License Number State | AZ
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