Provider Demographics
NPI:1487169520
Name:WACHTEL, JOHN M (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WACHTEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7301 E 2ND ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5610
Mailing Address - Country:US
Mailing Address - Phone:480-947-0321
Mailing Address - Fax:480-947-1177
Practice Address - Street 1:7301 E 2ND ST STE 208
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5610
Practice Address - Country:US
Practice Address - Phone:480-947-0321
Practice Address - Fax:480-947-1177
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD049411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics