| Chandler Pediatric Dental | |
|
2095 W Frye Rd Ste 2 Chandler AZ 85224-6280 | |
| (480) 855-8315 | |
| (480) 855-8316 |
| Full Name | Chandler Pediatric Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2095 W Frye Rd Ste 2, Chandler, Arizona |
| Authorized Official Name and Position | Robert William Scoresby (OWNER) |
| Authorized Official Contact | 4808558315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chandler Pediatric Dental 655 S Dobson Rd Building B Suite 214 Chandler AZ 85224-5667 Ph: (480) 855-1315 | Chandler Pediatric Dental 2095 W Frye Rd Ste 2 Chandler AZ 85224-6280 Ph: (480) 855-8315 |
| NPI Number | 1417176199 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 02/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417176199 | NPI | - | NPPES |
| 535113 | Medicaid | AZ | |
| 814503 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D7962 (Arizona) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (Arizona) | Primary |
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