Provider Demographics
NPI:1205906187
Name:NORTH SCOTTSDALE FAMILY DENTISTRY
Entity type:Organization
Organization Name:NORTH SCOTTSDALE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-614-1122
Mailing Address - Street 1:9070 E DESERT COVE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6227
Mailing Address - Country:US
Mailing Address - Phone:480-614-1122
Mailing Address - Fax:480-614-1226
Practice Address - Street 1:9070 E DESERT COVE AVE
Practice Address - Street 2:STE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6227
Practice Address - Country:US
Practice Address - Phone:480-614-1122
Practice Address - Fax:480-614-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3607122300000X
AZ3469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty