Provider Demographics
NPI:1689895765
Name:RIDGE DENTAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:RIDGE DENTAL SPECIALISTS LLC
Other - Org Name:CANYON RIDGE ENDODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAMMOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-538-8100
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:US
Mailing Address - Phone:480-538-8100
Mailing Address - Fax:480-538-8101
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050
Practice Address - Country:US
Practice Address - Phone:480-538-8100
Practice Address - Fax:480-538-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD62781223E0200X
AZD63381223E0200X
AZD69321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty