Provider Demographics
NPI:1952514572
Name:BRENDA TAEGE, DDS, LLC
Entity Type:Organization
Organization Name:BRENDA TAEGE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAEGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-860-6744
Mailing Address - Street 1:8416 E SHEA BLVD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6666
Mailing Address - Country:US
Mailing Address - Phone:480-860-6744
Mailing Address - Fax:480-860-8777
Practice Address - Street 1:8416 E SHEA BLVD
Practice Address - Street 2:SUITE C100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6666
Practice Address - Country:US
Practice Address - Phone:480-860-6744
Practice Address - Fax:480-860-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD59411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty