# FLAGSTAFF ENDODONTICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083799639
- **Authorized official:** MS. TANIA MADDY (RECEPTIONIST)
- **Authorized official phone:** (928) 774-4400

## Contact information

- **Practice address:** 1600 W UNIVERSITY AVE STE 103, FLAGSTAFF, AZ 86001-3154
- **Practice address phone:** (928) 774-4400
- **Practice address fax:** (928) 774-5436
- **Mailing address:** 1600 W UNIVERSITY AVE STE 103, FLAGSTAFF, AZ 86001-3154
- **Mailing address phone:** (928) 774-4400
- **Mailing address fax:** (928) 774-5436

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 2197 | AZ | — |
| 1223E0200X | Endodontics | 6531 | AZ | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 01/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2197 | DENTAL LICENSE NO. | AZ |
| 01 | — | 6531 | DENTAL LICENSE NO. | AZ |