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General NPI Number Information
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NPI Number | 1205603206
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Entity Type | Organization
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Legal Business Name | PEDIATRIC TONGUE TIE
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 7600 E CAMELBACK RD STE 8B
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2106
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Country | US
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Telephone | 480-331-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 E CAMELBACK RD STE 8B
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2106
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Country | US
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Telephone | 480-331-5929
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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. VERONICA MARTINEZ
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Credential | DDS
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Telephone | 480-282-6746
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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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