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General NPI Number Information
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NPI Number | 1487773529
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Entity Type | Individual
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Provider Name | ENRICO E. DIVITO D.D.S., P.C.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1525 N GRANITE REEF RD STE 12
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3998
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Country | US
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Telephone | 480-990-1905
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Fax | 480-990-2311
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Provider Business Mailing Address
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Address Line | 1525 N GRANITE REEF RD STE 12
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3998
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Country | US
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Telephone | 480-990-1905
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Fax | 480-990-2311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2556
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License Number State | AZ
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