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General NPI Number Information
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NPI Number | 1427230770
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Entity Type | Organization
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Legal Business Name | JOHNSON RANCH FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 270 E HUNT HWY BLDG. 3, SUITE 14
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City | QUEEN CREEK
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State | AZ
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Zip | 85243-4962
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Country | US
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Telephone | 480-888-2271
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Fax | 480-888-7474
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Provider Business Mailing Address
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Address Line | 270 E HUNT HWY BLDG. 3, SUITE 14
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City | QUEEN CREEK
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State | AZ
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Zip | 85243-4962
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Country | US
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Telephone | 480-888-2271
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Fax | 480-888-7474
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SCOTT DEE WALLIN
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Credential | DDSM , PC
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Telephone | 480-888-2271
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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 | 5868
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License Number State | AZ
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