Provider Demographics
NPI:1194247098
Name:SCOTTSDALE PROSTHODONTISTS II, PLLC
Entity type:Organization
Organization Name:SCOTTSDALE PROSTHODONTISTS II, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-368-0060
Mailing Address - Street 1:11111 N SCOTTSDALE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6732
Mailing Address - Country:US
Mailing Address - Phone:480-368-0600
Mailing Address - Fax:
Practice Address - Street 1:11111 N SCOTTSDALE RD STE 220
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6732
Practice Address - Country:US
Practice Address - Phone:480-368-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty