OrganizationActive
Tatum Blvd Dentistry, LLC
NPI 1104034909 · Dentist · Phoenix, AZ
Tatum Blvd Dentistry, LLC is a Dentist organization in Phoenix, AZ (NPI 1104034909).
Provider details
- NPI number
- 1104034909
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Brad Wyatt, Dentist(602) 944-0073
- License
- D5926 (AZ)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
11110 N Tatum Blvd
Suite 102
Phoenix, AZ 85028-1607
Phone: (602) 977-1110
Fax: (602) 795-1420
Street-level locationGet directions
Mailing address
2323 W Mescal St
Phoenix, AZ 85029-4764
Registry dates
- Enumerated
- 2007-05-18
- Last updated
- 2020-08-22
Frequently asked questions
- What is Tatum Blvd Dentistry, LLC's NPI number?
- Tatum Blvd Dentistry, LLC's National Provider Identifier (NPI) is 1104034909, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Tatum Blvd Dentistry, LLC?
- Tatum Blvd Dentistry, LLC is classified in the NPPES registry as Dentist (Dental Providers).
- Where is Tatum Blvd Dentistry, LLC located?
- Tatum Blvd Dentistry, LLC's practice location on file with NPPES is 11110 N Tatum Blvd, Phoenix, AZ 85028-1607.
- What is Tatum Blvd Dentistry, LLC's phone number?
- The practice phone number listed in the NPPES registry for Tatum Blvd Dentistry, LLC is (602) 977-1110.
- Who is the authorized official for Tatum Blvd Dentistry, LLC?
- The authorized official listed on Tatum Blvd Dentistry, LLC's NPPES record is Brad Wyatt, Dentist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Tatum Blvd Dentistry, LLC's NPI active?
- Yes — Tatum Blvd Dentistry, LLC's NPI (1104034909) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.