MEDICARE: VANDER SCHAAF PC

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	4398	AZ
2	1223G0001X	General Practice Dentistry	4426	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	826546	OTHER		UNITED CONCORDIA

General Provider Information

NPI Number	:	1063577393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDER SCHAAF PC

Provider Business Mailing Address
First Line	:	7301 E THOMAS ROAD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7215
Country	:	US
Telephone Number	:	480-994-5225
Fax Number	:	480-947-8866

Provider Business Practice Location Address
First Line	:	7301 E THOMAS ROAD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7215
Country	:	US
Telephone Number	:	480-994-5225
Fax Number	:	480-947-8866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BETH D VANDER SCHAAF
Credential	:	DDS
Telephone Number	:	480-994-5225

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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Directions to “VANDER SCHAAF PC ” Practice Location

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