Tatum Blvd Dentistry, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D5926 Issued in AZ

Legal business name

TATUM BLVD DENTISTRY, LLC

Practice address

11110 N Tatum Blvd
Suite 102
Phoenix, AZ 85028-1607

Phone

(602) 977-1110

Fax

(602) 795-1420

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brad Wyatt, DMD

Title

Dentist

Phone

(602) 944-0073

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Abzug

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1871648543
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104034909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 W MESCAL ST",
            "address_2": "SUITE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294764",
            "telephone_number": "602-944-0073",
            "fax_number": "602-944-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 N TATUM BLVD",
            "address_2": "SUITE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281607",
            "telephone_number": "602-977-1110",
            "fax_number": "602-795-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TATUM BLVD DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "602-944-0073",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Tatevosyan
• Paige Tatge
• Joo Nam Tatham, PMHNP-BC
• Christopher Tatsumi, LMSW
• Tatum Anesthesia Group LLC
• Tatum Facility, LLC
• Tatum Highlands Medical Associates PLC
• Tatum Internal Medicine & Associates PLLC
• Tatum Pain Ventures LLC
• Tatum Point Chiropractic, Inc

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.