# THOMAS S DURISEK, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Open Wide Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295919751
- **Authorized official:** THOMAS SCOTT DURISEK DDS (PRESIDENT)
- **Authorized official phone:** (602) 347-9999

## Contact information

- **Practice address:** 6520 N 7TH AVE, SUITE \#1, PHOENIX, AZ 85013-1158
- **Practice address phone:** (602) 347-9999
- **Mailing address:** 6520 N 7TH AVE, SUITE \#1, PHOENIX, AZ 85013-1158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 4777 | AZ | Yes |

## Other

- **Enumeration date:** 12/19/2007
- **Last updated:** 12/19/2007