Provider Demographics
NPI:1114724218
Name:BRET S. STANDAGE DMD PLLC
Entity type:Organization
Organization Name:BRET S. STANDAGE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-657-6357
Mailing Address - Street 1:10850 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6717
Mailing Address - Country:US
Mailing Address - Phone:480-657-6357
Mailing Address - Fax:480-657-8951
Practice Address - Street 1:10850 N 90TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6717
Practice Address - Country:US
Practice Address - Phone:480-657-6357
Practice Address - Fax:480-657-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty