Provider Demographics
NPI:1972678704
Name:HOM, DONALD TUNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TUNE
Last Name:HOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 N 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5019
Mailing Address - Country:US
Mailing Address - Phone:480-922-2669
Mailing Address - Fax:866-472-4740
Practice Address - Street 1:625 W SOUTHERN AVE
Practice Address - Street 2:SUITE E-145
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5030
Practice Address - Country:US
Practice Address - Phone:480-922-2669
Practice Address - Fax:866-472-4740
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58191223G0001X
AZD58191223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice