Provider Demographics
NPI:1609869049
Name:BERTZ, JAMES E (DDS,MD,FACS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BERTZ
Suffix:
Gender:M
Credentials:DDS,MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-945-0663
Mailing Address - Fax:480-947-3991
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:STE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-945-0663
Practice Address - Fax:480-947-3991
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26561223S0112X
AZ12096204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG29953Medicare UPIN
AZZMD12096Medicare ID - Type Unspecified