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General NPI Number Information
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NPI Number | 1730238106
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Entity Type | Individual
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Provider Name | BRIAN DEDINSKY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 367 E VIRGINIA AVE
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City | PHOENIX
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State | AZ
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Zip | 85004-1202
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Country | US
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Telephone | 602-256-6303
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Fax | 602-256-6302
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Provider Business Mailing Address
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Address Line | 7309 N LAKESIDE LN
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-2836
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Country | US
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Telephone | 602-405-3399
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Fax | 602-256-6302
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AZ20400
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License Number State | AZ
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