Provider Demographics
NPI:1033380316
Name:OCOTILLO TRAILS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OCOTILLO TRAILS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHEERHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-358-1675
Mailing Address - Street 1:40975 N IRONWOOD RD
Mailing Address - Street 2:#A102
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85240-8906
Mailing Address - Country:US
Mailing Address - Phone:480-457-1977
Mailing Address - Fax:
Practice Address - Street 1:40975 N IRONWOOD RD
Practice Address - Street 2:#A102
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85240-8906
Practice Address - Country:US
Practice Address - Phone:480-457-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty