Provider Demographics
NPI:1386420586
Name:FOXTROT DENTAL
Entity type:Organization
Organization Name:FOXTROT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LIVSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-419-3993
Mailing Address - Street 1:6868 E BECKER LN STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6708
Mailing Address - Country:US
Mailing Address - Phone:480-595-5966
Mailing Address - Fax:
Practice Address - Street 1:6868 E BECKER LN STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6708
Practice Address - Country:US
Practice Address - Phone:480-595-5966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental