Provider Demographics
NPI:1629289491
Name:NORTHWEST ENDODONTICS
Entity Type:Organization
Organization Name:NORTHWEST ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-979-1313
Mailing Address - Street 1:7972 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4903
Mailing Address - Country:US
Mailing Address - Phone:623-979-1313
Mailing Address - Fax:623-505-3678
Practice Address - Street 1:7972 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4903
Practice Address - Country:US
Practice Address - Phone:623-979-1313
Practice Address - Fax:623-505-3678
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
AZ49481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty