Provider Demographics
NPI:1306298955
Name:SMART BRAIN AGING INC
Entity type:Organization
Organization Name:SMART BRAIN AGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DENBOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-510-9217
Mailing Address - Street 1:8130 E CACTUS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5263
Mailing Address - Country:US
Mailing Address - Phone:480-993-3879
Mailing Address - Fax:480-935-0964
Practice Address - Street 1:8130 E CACTUS RD STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5263
Practice Address - Country:US
Practice Address - Phone:480-993-3879
Practice Address - Fax:480-935-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty