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General NPI Number Information
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NPI Number | 1669992194
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Entity Type | Individual
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Provider Name | BENJAMIN JOSEPH WACHTER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 2510 E HUNT HWY STE 29
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-5208
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Country | US
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Telephone | 480-582-0753
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Fax |
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Provider Business Mailing Address
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Address Line | 633 N ROANOKE
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City | MESA
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State | AZ
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Zip | 85205-6308
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Country | US
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Telephone | 480-907-4824
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D009789
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License Number State | AZ
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