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General NPI Number Information
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NPI Number | 1134694698
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Entity Type | Organization
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Legal Business Name | DENTISTS OF PHOENIX, LLP
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1934 E CAMELBACK RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85016-4126
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Country | US
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Telephone | 602-903-4894
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Fax | 602-675-9843
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Provider Business Mailing Address
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Address Line | 1934 E CAMELBACK RD STE 110
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City | PHOENIX
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State | AZ
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Zip | 85016-4126
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Country | US
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Telephone | 602-903-4894
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Fax | 602-675-9843
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | BEN J HIMMELSTEIN
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Credential |
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Telephone | 602-903-4849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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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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