MEDICARE: RYAN C WAIT

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8044	AZ

General Provider Information

NPI Number	:	1104128610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN C WAIT

Provider Business Mailing Address
First Line	:	10629 N 71ST PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5273
Country	:	US
Telephone Number	:	480-998-1188
Fax Number	:	480-948-0516

Provider Business Practice Location Address
First Line	:	10629 N 71ST PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5273
Country	:	US
Telephone Number	:	480-998-1188
Fax Number	:	480-948-0516

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

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	06/24/2015

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Directions to “ RYAN C WAIT ” Practice Location

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