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General NPI Number Information
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NPI Number | 1952514572
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Entity Type | Organization
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Legal Business Name | BRENDA TAEGE, DDS, LLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 8416 E SHEA BLVD SUITE C100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6666
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Country | US
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Telephone | 480-860-6744
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Fax | 480-860-8777
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Provider Business Mailing Address
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Address Line | 8416 E SHEA BLVD SUITE C100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6666
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Country | US
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Telephone | 480-860-6744
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Fax | 480-860-8777
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BRENDA TAEGE
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Credential | D.D.S.
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Telephone | 480-860-6744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D5941
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License Number State | AZ
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