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General NPI Number Information
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NPI Number | 1811489941
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Entity Type | Organization
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Legal Business Name | ONE HUNDRED DENTAL PLLC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 11000 N SCOTTSDALE RD STE 290
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City | SCOTTSDALE
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State | AZ
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Zip | 85254
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Country | US
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Telephone | 480-426-0135
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Fax | 480-676-1626
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Provider Business Mailing Address
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Address Line | 11000 N SCOTTSDALE RD STE 290
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5269
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Country | US
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Telephone | 480-426-0135
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Fax | 480-676-1626
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. GERALD PAIK
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Credential | DDS
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Telephone | 480-426-0135
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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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