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General NPI Number Information
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NPI Number | 1447655386
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Entity Type | Organization
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Legal Business Name | BRANNON WALDMAN DENTAL GROUP
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 21809 N SCOTTSDALE RD C 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7440
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Country | US
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Telephone | 480-563-0000
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Fax | 480-563-4445
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Provider Business Mailing Address
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Address Line | 21809 N SCOTTSDALE RD C 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7440
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Country | US
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Telephone | 480-563-0000
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Fax | 480-563-4445
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK BRANNON
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Credential | DDS
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Telephone | 480-563-0000
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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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