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General NPI Number Information
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NPI Number | 1174062095
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Entity Type | Individual
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Provider Name | JOSHUA JAMES HEYREND D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 3244 S MILL AVE STE 105
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City | TEMPE
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State | AZ
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Zip | 85282-3688
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Country | US
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Telephone | 480-355-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 3244 S MILL AVE STE 105
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City | TEMPE
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State | AZ
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Zip | 85282-3688
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Country | US
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Telephone | 480-355-4131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D-4918
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D010686
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License Number State | AZ
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