Provider Demographics
NPI:1447095351
Name:ELLSWORTH DENHAM, VERITY (RDH, BS)
Entity type:Individual
Prefix:MRS
First Name:VERITY
Middle Name:
Last Name:ELLSWORTH DENHAM
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 N METRO PKWY W
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1402
Mailing Address - Country:US
Mailing Address - Phone:480-964-2273
Mailing Address - Fax:
Practice Address - Street 1:9610 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1402
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH008209124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist