Provider Demographics
NPI:1043440068
Name:WASSON, MICHAEL HOUSTON (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOUSTON
Last Name:WASSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 N 92ND ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4520
Mailing Address - Country:US
Mailing Address - Phone:480-896-0600
Mailing Address - Fax:
Practice Address - Street 1:10250 N 92ND ST STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4520
Practice Address - Country:US
Practice Address - Phone:480-896-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0111651223S0112X
TX248061223G0001X
WADR602135191223S0112X
WADE60489331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice