# SSPDENTAL

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

## Provider details

- **NPI number:** 1215680004
- **Authorized official:** DR. PRACHI TYAGI DDS (OWNER)
- **Authorized official phone:** (310) 254-8100

## Contact information

- **Practice address:** 1618 E BELL RD STE 108, PHOENIX, AZ 85022-2835
- **Practice address phone:** (602) 493-0206
- **Mailing address:** 5623 E ASTER DR, SCOTTSDALE, AZ 85254-4305
- **Mailing address phone:** (310) 254-8100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/01/2022
- **Last updated:** 02/01/2022