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General NPI Number Information
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NPI Number | 1215320551
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Entity Type | Organization
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Legal Business Name | MICHAEL D HUMMITZSCH DDS PC
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 10665 W INDIAN SCHOOL RD SUITE J
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City | AVONDALE
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State | AZ
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Zip | 85392-5642
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Country | US
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Telephone | 623-772-5362
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Fax | 623-772-6036
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Provider Business Mailing Address
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Address Line | 10665 W INDIAN SCHOOL RD SUITE J
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City | AVONDALE
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State | AZ
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Zip | 85392-5642
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Country | US
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Telephone | 623-772-5362
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Fax | 623-772-6036
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL DAVID HUMMITZSCH
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Credential | D.D.S.
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Telephone | 623-772-5362
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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 |
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License Number State |
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