=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457813487
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD CATTRON DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2019
-----------------------------------------------------
Last Update Date | 01/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15990 S RANCHO SAHUARITA BLVD STE 110
-----------------------------------------------------
City | SAHUARITA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85629-8022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-363-4774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10447 S BOOTHILL WAY
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85641-6846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-535-8591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | D011273
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------