Organization
FLAGSTAFF ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANIA MADDY (RECEPTIONIST)
(928) 774-4400
Entity
Organization
Contact information
Practice address
1600 W UNIVERSITY AVE STE 103, FLAGSTAFF, AZ 86001-3154
(928) 774-4400
(928) 774-5436
Mailing address
1600 W UNIVERSITY AVE STE 103, FLAGSTAFF, AZ 86001-3154
(928) 774-4400
(928) 774-5436
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
2197
AZ
1223E0200X
Endodontics
Primary
6531
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2197
DENTAL LICENSE NO.
AZ
01
—
6531
DENTAL LICENSE NO.
AZ
Enumeration date
10/25/2006
Last updated
01/18/2017
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