Organization
SMART BRAIN AGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN M DENBOER PHD (PRESIDENT)
(480) 861-0020
Entity
Organization
Contact information
Practice address
7878 N 16TH ST, SUITE 250, PHOENIX, AZ 85020-4449
(602) 395-0715
(602) 277-8146
Mailing address
275 N GATEWAY DR, SUITE 100, PHOENIX, AZ 85034-1700
(185) 527-6278
(602) 277-8146
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
4026
AZ
Other
Enumeration date
05/20/2016
Last updated
05/20/2016
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