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General NPI Number Information
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NPI Number | 1871098269
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Entity Type | Organization
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Legal Business Name | NORTH PHOENIX PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 1526 W GLENDALE AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85021-8576
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Country | US
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Telephone | 602-864-1080
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Fax | 602-864-7036
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Provider Business Mailing Address
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Address Line | 1526 W GLENDALE AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85021-8576
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Country | US
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Telephone | 602-864-1080
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Fax | 602-864-7036
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | WILLIAM JOSEPH HEIMANN
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Credential | DDS
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Telephone | 602-864-1080
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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 | 2542
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License Number State | AZ
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