Provider Demographics
NPI:1376926576
Name:SCOTTSDALE DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:SCOTTSDALE DENTAL PARTNERS PLLC
Other - Org Name:COMFORT DENTALEAST MESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-218-9720
Mailing Address - Street 1:6949 E SHEA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6146
Mailing Address - Country:US
Mailing Address - Phone:480-459-2144
Mailing Address - Fax:
Practice Address - Street 1:6949 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6146
Practice Address - Country:US
Practice Address - Phone:480-459-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty