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General NPI Number Information
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NPI Number | 1265625552
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Entity Type | Organization
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Legal Business Name | SAN TAN PEDIATRIC DENTAL
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 2510 E HUNT HWY SUITE #29
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City | QUEEN CREEK
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State | AZ
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Zip | 85243-5206
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Country | US
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Telephone | 480-457-1693
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Fax | 480-457-1321
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Provider Business Mailing Address
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Address Line | 2510 E HUNT HWY SUITE #29
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City | QUEEN CREEK
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State | AZ
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Zip | 85243-5206
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Country | US
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Telephone | 480-457-1693
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Fax | 480-457-1321
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN J MONTOYA
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Credential | D.D.S.
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Telephone | 480-457-1693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7384
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License Number State | AZ
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