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General NPI Number Information
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NPI Number | 1770208498
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Entity Type | Organization
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Legal Business Name | DAN RODDA, DDS, PLLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 15255 N 40TH ST STE 141
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City | PHOENIX
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State | AZ
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Zip | 85032-4682
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Country | US
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Telephone | 928-525-4642
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Fax |
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Provider Business Mailing Address
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Address Line | 449 W WULFENITE RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86005-6836
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Country | US
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Telephone | 928-525-4642
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Fax |
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DAN RODDA
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Credential | DDS
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Telephone | 928-525-4642
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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 |
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License Number State |
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