Provider Demographics
NPI:1659308641
Name:NORTH VALLEY ENDODONTICS, P.A.
Entity Type:Organization
Organization Name:NORTH VALLEY ENDODONTICS, P.A.
Other - Org Name:VALLEY ENDODONTICS AND ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENEBRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-734-4518
Mailing Address - Street 1:8121 E INDIAN BEND RD STE 128
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4820
Mailing Address - Country:US
Mailing Address - Phone:026-734-4518
Mailing Address - Fax:602-482-7021
Practice Address - Street 1:702 E BELL RD STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6639
Practice Address - Country:US
Practice Address - Phone:602-404-3800
Practice Address - Fax:602-404-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164880779Medicaid
AZ1326230632Medicaid
AZ1548791486Medicaid
AZ1700298262Medicaid
AZ1013359603Medicaid
AZ1174922025Medicaid
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AZ1699749978Medicaid
AZ1740486737Medicaid
AZ1477520146Medicaid
AZ1558600643Medicaid
AZ1205192663Medicaid
AZ1366857518Medicaid
AZ1679878938Medicaid
AZ1518218825Medicaid
AZ1770937146Medicaid
AZ1649313313Medicaid
AZ1730486630Medicaid
AZ1821260951Medicaid
AZ1972713493Medicaid
AZ1548657315Medicaid