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General NPI Number Information
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NPI Number | 1962703496
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Entity Type | Organization
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Legal Business Name | TEMPE MODERN DENTISTRY, LLP
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 1835 E GUADALUPE RD STE C-107
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City | TEMPE
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State | AZ
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Zip | 85283-3277
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Country | US
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Telephone | 480-345-4017
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Fax | 480-345-3526
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE FL 2
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City | IRVINE
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State | CA
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Zip | 92606-1008
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN D YOUNG
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Credential | DMD
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Telephone | 480-345-4017
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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 |
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License Number State |
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