Provider Demographics
NPI:1700506326
Name:IRONWOOD PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:IRONWOOD PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIMMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-229-7498
Mailing Address - Street 1:10213 N 92ND ST STE H102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4561
Mailing Address - Country:US
Mailing Address - Phone:480-422-4544
Mailing Address - Fax:480-307-9957
Practice Address - Street 1:10213 N 92ND ST STE H102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4561
Practice Address - Country:US
Practice Address - Phone:480-422-4544
Practice Address - Fax:480-307-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty