| Tatum Blvd Dentistry, Llc | |
|
11110 N Tatum Blvd Suite 102 Phoenix AZ 85028-1607 | |
| (602) 977-1110 | |
| (602) 795-1420 |
| Full Name | Tatum Blvd Dentistry, Llc |
|---|---|
| Speciality | Dentist |
| Location | 11110 N Tatum Blvd, Phoenix, Arizona |
| Authorized Official Name and Position | Brad Wyatt (DENTIST) |
| Authorized Official Contact | 6029440073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tatum Blvd Dentistry, Llc 2323 W Mescal St Suite 205 Phoenix AZ 85029-4764 Ph: (602) 944-0073 | Tatum Blvd Dentistry, Llc 11110 N Tatum Blvd Suite 102 Phoenix AZ 85028-1607 Ph: (602) 977-1110 |
| NPI Number | 1104034909 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104034909 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D5926 (Arizona) | Primary |
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