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General NPI Number Information
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NPI Number | 1821135732
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Entity Type | Organization
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Legal Business Name | PARADISE VALLEY DENTAL GROUP PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6865 E. BECKER LANE #100
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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 | 480-483-8067
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Fax | 480-483-8471
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Provider Business Mailing Address
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Address Line | 6865 E. BECKER LANE #100
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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 | 480-483-8067
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Fax | 480-483-8471
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Authorized Official
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Title or Position | DENTIST - OWNER
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Name | DR. BARRY J NESTLERODE
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Credential | DDS
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Telephone | 480-483-8067
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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 | AZ4495
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License Number State | AZ
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