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General NPI Number Information
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NPI Number | 1689704900
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Entity Type | Organization
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Legal Business Name | BRIAN L WOOLSEY DDS PC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 4444 N 32ND ST STE 240
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City | PHOENIX
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State | AZ
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Zip | 85018
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Country | US
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Telephone | 602-955-1500
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Fax | 602-955-6309
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Provider Business Mailing Address
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Address Line | 4444 N 32ND ST STE 240
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City | PHOENIX
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State | AZ
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Zip | 85018
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Country | US
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Telephone | 602-955-1500
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Fax | 602-955-6309
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN L WOOLSEY
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Credential | DDS
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Telephone | 60295551500
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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 | 4380
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License Number State | AZ
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