MEDICARE: DR. AMY MARIE NORDQUIST D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D008427	AZ

General Provider Information

NPI Number	:	1023365764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY MARIE NORDQUIST D.D.S.

Provider Business Mailing Address
First Line	:	1202 E ZION WAY
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-5191
Country	:	US
Telephone Number	:	480-706-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	15215 S 48TH ST STE 190
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-9140
Country	:	US
Telephone Number	:	480-706-0029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	10/16/2020

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