Provider Demographics
NPI:1265645873
Name:TAEGE, BRENDA (DDS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TAEGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 E SHEA BLVD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6666
Mailing Address - Country:US
Mailing Address - Phone:480-860-6744
Mailing Address - Fax:480-860-8777
Practice Address - Street 1:8416 E SHEA BLVD
Practice Address - Street 2:SUITE C100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6666
Practice Address - Country:US
Practice Address - Phone:480-860-6744
Practice Address - Fax:480-860-8777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD59411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice