1659308641 NPI number — NORTH VALLEY ENDODONTICS, P.A.

Table of content: (NPI 1659308641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659308641 NPI number — NORTH VALLEY ENDODONTICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH VALLEY ENDODONTICS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY ENDODONTICS AND ORAL SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659308641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8121 E INDIAN BEND RD STE 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-4820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
26-734-4518
Provider Business Mailing Address Fax Number:
602-482-7021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 E BELL RD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-6639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-404-3800
Provider Business Practice Location Address Fax Number:
602-404-0983
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENEBRY
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
602-734-4518

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  4411 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1164880779 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326230632 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548791486 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700298262 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013359603 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174922025 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336281856 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699749978 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740486737 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477520146 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558600643 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205192663 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366857518 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679878938 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518218825 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770937146 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649313313 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730486630 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821260951 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972713493 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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