Provider Demographics
NPI:1689403362
Name:JEFFREY STYSKAL DENTISTRY PLLC
Entity type:Organization
Organization Name:JEFFREY STYSKAL DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STYSKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-314-2700
Mailing Address - Street 1:6819 E WINCHCOMB DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3470
Mailing Address - Country:US
Mailing Address - Phone:310-591-7878
Mailing Address - Fax:
Practice Address - Street 1:9180 E DESERT COVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6254
Practice Address - Country:US
Practice Address - Phone:480-314-2700
Practice Address - Fax:480-314-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty