Provider Demographics
NPI:1992971204
Name:AZTMJ, PLLC
Entity type:Organization
Organization Name:AZTMJ, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-945-3629
Mailing Address - Street 1:9481 E IRONWOOD SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4568
Mailing Address - Country:US
Mailing Address - Phone:480-945-3629
Mailing Address - Fax:480-664-8972
Practice Address - Street 1:9481 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4568
Practice Address - Country:US
Practice Address - Phone:480-945-3629
Practice Address - Fax:480-664-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty