Organization
SSPDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRACHI TYAGI DDS (OWNER)
(310) 254-8100
Entity
Organization
Contact information
Practice address
1618 E BELL RD STE 108, PHOENIX, AZ 85022-2835
(602) 493-0206
Mailing address
5623 E ASTER DR, SCOTTSDALE, AZ 85254-4305
(310) 254-8100
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/01/2022
Last updated
02/01/2022
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