Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tatum Blvd Dentistry, LLC

Organization Dentist · NPI 1104034909

Tatum Blvd Dentistry, LLC is a Dentist in Phoenix, Arizona. Licensed in Arizona. Registered with an NPI since 2007.

Licensed in
AZ
In the registry since
2007
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11110 N Tatum Blvd Ste 102
Phoenix, AZ 85028-1607
Phone: (602) 977-1110
Fax: (602) 795-1420
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D5926 (AZ)

Record details

NPI number1104034909
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brad Wyatt — Dentist · (602) 944-0073
NPI enumeratedMay 18, 2007
Last updated in NPPESAugust 22, 2020
Mailing address2323 W Mescal St, Suite 205, Phoenix, AZ 85029-4764

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