Provider Demographics
NPI:1538115662
Name:ENT SPECIALISTS OF ARIZONA, P.C.
Entity Type:Organization
Organization Name:ENT SPECIALISTS OF ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-894-5550
Mailing Address - Street 1:1492 S MILL AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5652
Mailing Address - Country:US
Mailing Address - Phone:480-894-5550
Mailing Address - Fax:480-894-9469
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:STE. 301
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5652
Practice Address - Country:US
Practice Address - Phone:480-894-5550
Practice Address - Fax:480-894-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698251Medicaid
AZZ70956Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
AZE54243Medicare UPIN