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General NPI Number Information
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NPI Number | 1184081804
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Entity Type | Organization
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Legal Business Name | ERIC R WIITALA DDS PLLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 9755 NORTH 90TH STREET SUITE B250
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5076
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Country | US
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Telephone | 480-657-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 9755 NORTH 90TH STREET SUITE B250
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5076
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Country | US
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Telephone | 480-657-6981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC R WIITALA
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Credential | DDS
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Telephone | 480-657-6981
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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 | D05388
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License Number State | AZ
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