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General NPI Number Information
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NPI Number | 1376926576
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE DENTAL PARTNERS PLLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 6949 E SHEA BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6146
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Country | US
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Telephone | 480-459-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 6949 E SHEA BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6146
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Country | US
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Telephone | 480-459-2144
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MICHAEL J STOOR
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Credential | DDS
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Telephone | 480-218-9720
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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 | D009160
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License Number State | AZ
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