Provider Demographics
NPI:1346451341
Name:AESTHETIC DENTISTRY OF SCOTTSDALE
Entity Type:Organization
Organization Name:AESTHETIC DENTISTRY OF SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-513-2620
Mailing Address - Street 1:9598 E SOUTHWIND LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3656
Mailing Address - Country:US
Mailing Address - Phone:480-223-7675
Mailing Address - Fax:
Practice Address - Street 1:9377 E BELL RD STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1505
Practice Address - Country:US
Practice Address - Phone:480-513-2620
Practice Address - Fax:480-513-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD54151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty