TATUM BLVD DENTISTRY, LLC (NPI# 1104034909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104034909 |
| Entity Type | Organization |
| Organization Name | TATUM BLVD DENTISTRY, LLC |
| Practice Address |
11110 N Tatum Blvd Suite 102 Phoenix AZ 85028-1607 |
| Mailing Address |
2323 W Mescal St Suite 205 Phoenix AZ 85029-4764 |
| Practice Telephone | 6029771110 |
| Practice Fax Number | 6027951420 |
| Mailing Telephone | 6029440073 |
| Mailing Fax Number | 6029440199 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. BRAD WYATT (DENTIST) |
| Authorized Official Telephone | 6029440073 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D5926 | AZ | Dental Providers |
| Street Address |
11110 N TATUM BLVD SUITE 102 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85028-1607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679566624 | Geriatric and Family Mental Health Services, LLC | Psychologist | 11110 N Tatum Blvd, 103, Phoenix, AZ 85028-1607 | 2005-08-24 |
| 1588897037 | Paradise Valley Center for Cosmetic and Comprehensive Dentistry, Pllc | Dentist | 11110 N Tatum Blvd, Suite 102, Phoenix, AZ 85028-1607 | 2009-09-01 |
| 1902093164 | Risa E. Newell, Ph.d., L.L.C. | Psychologist | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2007-10-01 |
| 1598986630 | Mi Le Tran Md PC | Psychiatry & Neurology | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2007-05-02 |
| 1871648543 | Mark Abzug | Dentist | 11110 N Tatum Blvd, Suite 102, Phoenix, AZ 85028-1607 | 2007-01-24 |
| 1629135389 | Mi Le Tran | Psychiatry & Neurology | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2007-01-02 |
| 1699790030 | Joan Marie Polansky | Psychologist | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2006-07-13 |
| 1801852991 | Larisa E Newell | Psychologist | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2006-04-26 |
| 1316930381 | Gary Neal Goodman | Psychologist | 11110 N Tatum Blvd, Suite 103, Phoenix, AZ 85028-1607 | 2005-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235626565 | Celice Korsten | Psychologist | 11020 N. Tatum Blvd., Ste. 100, Phoenix, AZ 85028 | 2018-04-23 |
| 1720591605 | Michele Kaplan | Counselor | 11640 N Tatum Blvd #3096, Phoenix, AZ 85028 | 2017-11-14 |
| 1154840304 | Faustino M. Gonzalez, Md PC | Anesthesiology | 11811 N. Tatum Blvd, Suite 3031, Phoenix, AZ 85028 | 2017-09-19 |
| 1679092514 | Savior Palliative Care LLC | Family Medicine | 4530 E Shea Blvd Ste 175, Phoenix, AZ 85028 | 2017-09-12 |
| 1437688892 | Harmony Behavioral Health | Behavioral Analyst | 3008 E Sierra St, Phoenix, AZ 85028 | 2017-06-08 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1720418379 | Alyssa Hale | Occupational Therapy Assistant | 4600 East Shea Boulevard, Suite 101, Phoenix, AZ 85028 | 2013-11-19 |
| 1932534476 | Stephen Howard Garber | Otolaryngology | 9607 N. 43rd Way, Phoenix, AZ 85028 | 2013-09-03 |
| 1366798050 | Irna Lynn Shamos | Clinical Neuropsychologist | 4516 East Onyx Avenue, Arizona Psychological Diagnostics, Plc, Phoenix, AZ 85028 | 2012-07-31 |
| 1285930925 | Cathy Ann Payne | Nurse Practitioner | 11209 N Tatum Blvd Ste 260, Phoenix, AZ 85028 | 2011-01-27 |
| Find all providers in zip 85028 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851990444 | Shaveta Behl | Dentist | 320 E Mcdowell Rd Ste 221, Phoenix, AZ 85004-4516 | 2020-10-23 |
| 1083212575 | Rasha Adil Abduljabbar Al-kaabi | Dentist | 4750 E Union Hills Dr Apt 1076, Phoenix, AZ 85050-3366 | 2020-10-15 |
| 1912510678 | Nicholas Ahn | Dentist | 1550 E Campbell Ave Apt 3028, Phoenix, AZ 85014-4271 | 2020-08-24 |
| 1326659087 | Triple Eight Dental Group, Pllc | Dentist | 7910 W Thomas Rd Ste 118, Phoenix, AZ 85033-4830 | 2020-08-14 |
| 1376154450 | Hatcher Dental Studio | Dentist | 421 W Hatcher Rd # 101, Phoenix, AZ 85021-2455 | 2020-08-12 |
| 1811515885 | Robert James Koch | Dentist | 2236 W Bethany Home Rd Ste 1, Phoenix, AZ 85015-1934 | 2020-07-07 |
| 1093332454 | James Dang | Dentist | 2777 E Camelback Rd Ste 101, Phoenix, AZ 85016-4348 | 2020-07-01 |
| 1639700735 | Swiss Biologic Dentistry, LLC | Dentist | 4202 N 32nd St Ste A, Phoenix, AZ 85018-4764 | 2020-01-28 |
| 1194370403 | Rajas Milind Pradhan | Dentist | 4201 E Bell Rd, Phoenix, AZ 85032-2211 | 2019-08-04 |
| 1396398806 | Aman Kaur | Dentist | 3320 W Southern Ave Ste 111, Phoenix, AZ 85041-4307 | 2019-07-23 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.