Organization
TATUM BLVD DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD WYATT DMD (DENTIST)
(602) 944-0073
Entity
Organization
Contact information
Practice address
11110 N TATUM BLVD, SUITE 102, PHOENIX, AZ 85028-1607
(602) 977-1110
(602) 795-1420
Mailing address
2323 W MESCAL ST, SUITE 205, PHOENIX, AZ 85029-4764
(602) 944-0073
(602) 944-0199
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5926
AZ
Other
Enumeration date
05/18/2007
Last updated
08/22/2020
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