=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679540496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN E. DENTZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 12/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 E MISSOURI AVE STE 300
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012-1351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-262-8917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3901 E BETHANY HOME RD
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-5008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-209-3360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 42633
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 59882
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------