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Organization

EAST SCOTTSDALE PEDIATRIC DENTAL, PC

Active
Other names
Dental Associates For Kids Only
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CANDACE H VENEBERG D.D.S (DIRECTOR)
(501) 850-5110
Entity
Organization

Contact information

Practice address
12020 E SHEA BLVD, STE 8, SCOTTSDALE, AZ 85259-4179
(480) 767-5600
Mailing address
12020 E SHEA BLVD, STE 8, SCOTTSDALE, AZ 85259-4179
(480) 767-5600

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D009209
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
064282
AZ
Enumeration date
09/21/2015
Last updated
10/18/2015
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