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General NPI Number Information
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NPI Number | 1528250693
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Entity Type | Organization
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Legal Business Name | FOUR PEAKS FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 3666 N MILLER RD 109
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4599
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Country | US
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Telephone | 480-994-9485
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Fax | 480-481-3800
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Provider Business Mailing Address
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Address Line | 3666 N MILLER RD 109
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4599
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Country | US
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Telephone | 480-994-9485
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Fax | 480-481-3800
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT CLARK III
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Credential | DDS
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Telephone | 480-994-9485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5498
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6575
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License Number State | AZ
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