Dentist Providers In Prescott, Arizona

Search Dentist NPI records in Prescott, AZ

Search or browse through the NPI records of dentist registered healthcare providers with a business address in Prescott, AZ. The listings include accepted insurance information, Medicare acceptance status, and PECOS enrollment data. The total number of NPI records is 101, of which 21 are registered as organizations and 80 as individuals. A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

79% Individuals

21% Organizations

9% Female

70% Male

79% Individual Providers (80)21% Medical Organizations (21)9% Female Providers (9)70% Male Providers (71)

Map of Providers

We have mapped the Dentist providers in Prescott, AZ to visually represent the practice location of each individual or organization. Click on any of the the pins to see the provider details at that location.

List of Providers

Table of Dentist NPI Profiles in Prescott, AZ
NPI	Name	Address	Insurance	Medicare	PECOS
1003292038	PRESCOTT DENTISTRY, PLLC (Organization)	350 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-1660		Non-Participating Provider	NO
1013138841	SERGIO GERARDO MONTES (Individual)	350 W. WHIPPLE ST. PRESCOTT, AZ 86301 (928) 445-1660		Non-Participating Provider	NO
1023452679	JARON BEAU PERKINS (Individual)	1306 W GURLEY ST PRESCOTT, AZ 86305 (928) 776-1700	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona Florida Combined Life Guardian Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1053150987	HORIZON DENTAL PDC PLLC (Organization)	919 12TH PL STE 7 PRESCOTT, AZ 86305 (928) 641-4000	BannerAetna UnitedHealthcare	Non-Participating Provider	NO
1053517185	MICHELE A BIBEAU (Individual)	1058 FAIR ST STE A PRESCOTT, AZ 86305 (928) 776-0606		Non-Participating Provider	NO
1063897411	HORIZON DENTAL GROUP PRESCOTT, LLC (Organization)	919 12TH PL PRESCOTT, AZ 86305 (928) 925-6522	Ambetter from Arizona Complete Health BannerAetna UnitedHealthcare	Non-Participating Provider	NO
1073670105	WALLACE ARNOLD DACHENHAUSEN (Individual)	1227 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-6684	Delta Dental of Arizona	Non-Participating Provider	NO
1073733481	JOHN JAMES STROPKO (Individual)	14770 N BRENDA RD PRESCOTT, AZ 86305 (602) 617-6767		Non-Participating Provider	NO
1073791919	KEITH L ROSDAHL (Individual)	1959 COMMERCE CENTER CIR. PRESCOTT, AZ 86301 (928) 771-8166	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Humana	Non-Participating Provider	NO
1083880082	MARK HAYDEN (Individual)	350 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-1660		Opted out of Medicare	YES
1093596348	HICKS DENTAL GROUP, LTD. (Organization)	108 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-6030		Non-Participating Provider	NO
1093775488	RICHARD C. JIRSA (Individual)	1229 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-2340	Delta Dental of Arizona	Opted out of Medicare	YES
1104106996	CAMERON D ANDREW (Individual)	1658 OAKLAWN DR STE B PRESCOTT, AZ 86305 (928) 771-1640	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana PacificSource Health Plans Paramount Paramount Dental	Non-Participating Provider	YES
1104200690	BARDIA SINAEI (Individual)	3124 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 350-6226	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Delta Dental of Arizona Renaissance Dental	Non-Participating Provider	YES
1104831908	ERVIN TRILLES (Individual)	1200 GAIL GARDNER WAY PRESCOTT, AZ 86305 (282) 274-3059	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental Solstice Healthplans of Arizona Inc. TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1104945682	CHRISTOPHER D SMITH (Individual)	1658 OAKLAWN DRIVE SUITE B PRESCOTT, AZ 86305 (928) 771-1640	Delta Dental of Arizona	Non-Participating Provider	YES
1114812849	ROYCE DARRIN MILGRIM (Individual)	1200 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 777-8550		Non-Participating Provider	NO
1134283187	JANE K. LAMBERTUS, DDS, PLLC FRONTIER VILLAGE DENTAL CARE (Organization)	1781 E STATE ROUTE 69 STE 9 PRESCOTT, AZ 86301 (928) 541-1000		Non-Participating Provider	NO
1134449481	TODD W WALKER (Individual)	3124 STILLWATER DR PRESCOTT, AZ 86305 (928) 460-1592	Delta Dental of Arizona	Opted out of Medicare	YES
1144359092	RANDY STEVEN HURLEY (Individual)	1151 W IRON SPRINGS RD SUITE F PRESCOTT, AZ 86305 (928) 771-2526	Guardian	Non-Participating Provider	NO
1184032328	KRISTIN STEELE (Individual)	980 WILLOW CREEK RD SUITE 103 PRESCOTT, AZ 86301 (928) 445-1682	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona Humana Renaissance Dental	Non-Participating Provider	YES
1194201145	THOMAS JOSEPH FREDERICK ARIETTA (Individual)	980 WILLOW CREEK RD STE 103 PRESCOTT, AZ 86301 (928) 460-5618	Aetna CVS Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona EMI Health Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1194257022	JORDAN CAMPBELL (Individual)	3185 CLEARWATER DR STE B PRESCOTT, AZ 86305 (928) 775-2545	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Cigna HealthCare of Arizona Inc Delta Dental of Arizona EMI Health Florida Combined Life Guardian Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Opted out of Medicare	YES
1194897165	JOSEPH BRETT MANGUM (Individual)	1767 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-4110	Delta Dental of Arizona Guardian	Non-Participating Provider	NO
1215032388	TONY J DALTON (Individual)	1055 RUTH ST SUITE 7 PRESCOTT, AZ 86301 (928) 445-5600	Anthem Blue Cross and Blue Shield BannerAetna Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona Guardian Humana	Non-Participating Provider	NO
1225565724	COURTNEY MARIE GOLER (Individual)	3626 CROSSINGS DR PRESCOTT, AZ 86305 (928) 445-5959	Blue Cross Blue Shield of Arizona Delta Dental of Arizona Humana	Non-Participating Provider	NO
1235294331	PHILIP ALLAN KUHNS (Individual)	1227 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-6684		Non-Participating Provider	NO
1245223957	CLAY C MAUPIN (Individual)	931 FAIR ST PRESCOTT, AZ 86305 (928) 445-3854		Non-Participating Provider	NO
1255564506	AN ELEGANT SMILE P.C. (Organization)	980 WILLOW CREEK RD STE 103 PRESCOTT, AZ 86301 (928) 445-1682		Non-Participating Provider	NO
1265587836	RYAN STANLEY BROWN (Individual)	3140 CLEARWATER DRIVE PRESCOTT, AZ 86305 (928) 445-5959	BannerAetna Blue Cross Blue Shield of Arizona Delta Dental of Arizona Guardian Humana	Non-Participating Provider	NO
1275925265	ORAL AND FACIAL SURGERY CENTER OF PRESCOTT (Organization)	5415 DISTICTION WAY PRESCOTT, AZ 86301 (205) 470-0047		Non-Participating Provider	NO
1306063250	MICHAEL B LEE (Individual)	1000 WILLOW CREEK RD STE H PRESCOTT, AZ 86301 (928) 693-7000	Ambetter from Arizona Complete Health Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental Renaissance Dental	Opted out of Medicare	YES
1316020100	ALLAN SZETO (Individual)	107 N CORTEZ ST SUITE 202 PRESCOTT, AZ 86301 (928) 778-2823	Anthem Blue Cross and Blue Shield BannerAetna Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Delta Dental of Arizona Humana Renaissance Dental	Non-Participating Provider	NO
1316954019	JAMES EVERETT CROCKETT (Individual)	1787 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 445-8980		Non-Participating Provider	NO
1326693912	BRADEN PAUL HICKS (Individual)	108 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-6030	Delta Dental of Arizona Guardian	Non-Participating Provider	NO
1336756865	HARRY WAYNE CHESSER (Individual)	222 S SUMMIT AVE STE 2 PRESCOTT, AZ 86303 (970) 852-0055	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Delta Dental of Arizona EMI Health Guardian Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY	Non-Participating Provider	YES
1346347234	KEVIN VINCENT RETHMAN (Individual)	1747 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-5527	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental Renaissance Dental	Opted out of Medicare	YES
1366639676	PRESCOTT SMILE CARE (Organization)	1055 RUTH ST SUITE #8 PRESCOTT, AZ 86301 (928) 445-8503		Non-Participating Provider	NO
1396705026	STANLEY K SWEET (Individual)	141 W NAVAJO DR PRESCOTT, AZ 86301 (928) 445-6145	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1407874662	JASON CLAY CAMPBELL (Individual)	139 W. WHIPPLE ST. PRESCOTT, AZ 86301 (928) 776-1208	Delta Dental of Arizona Guardian	Non-Participating Provider	NO
1427587005	POLINA JAYEVNA MAGEE (Individual)	980 WILLOW CREEK RD STE 103 PRESCOTT, AZ 86301 (928) 460-5618	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona EMI Health Florida Combined Life Guardian Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1447326228	RICHARD TURNER MANGUM (Individual)	1767 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-4110	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona	Non-Participating Provider	NO
1447486253	AARON MICHAEL WULFF (Individual)	3140 STILLWATER DR STE B PRESCOTT, AZ 86305 (928) 445-3181	BannerAetna Cigna Healthcare Delta Dental of Arizona	Non-Participating Provider	YES
1457168288	ALLEN SARA (Individual)	3150 CLEARWATER DR PRESCOTT, AZ 86305 (928) 445-7051		Non-Participating Provider	NO
1457439978	PETER J BOWER (Individual)	701 W HILLSIDE AVE PRESCOTT, AZ 86301 (928) 541-9000	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona	Non-Participating Provider	NO
1457523680	JAMES SPURGEON (Individual)	222 S SUMMIT AVE STE 2 PRESCOTT, AZ 86303 (928) 445-2440		Non-Participating Provider	NO
1457543613	KENNETH GLASS (Individual)	680 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 445-9233	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona Guardian Humana Renaissance Dental	Non-Participating Provider	NO
1467710541	NORTHERN ARIZONA ENDODONTICS (Organization)	1000 WILLOW CREEK RD STE K PRESCOTT, AZ 86301 (928) 778-7181	Ambetter from Arizona Complete Health UnitedHealthcare	Non-Participating Provider	NO
1467867531	DAVID P HERBERT, DDS, PLLC (Organization)	1787 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 445-8980		Non-Participating Provider	NO
1477667095	RICHARD BOYD SNOW (Individual)	919 12TH PL STE 12 PRESCOTT, AZ 86305 (928) 445-8482	Anthem Blue Cross and Blue Shield Delta Dental of Arizona	Non-Participating Provider	NO
1487859310	ROBERT JAMES CARLISI (Individual)	919 TWELFTH PLACE SUITE 9 PRESCOTT, AZ 86305 (928) 445-5877	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona EMI Health Guardian Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY	Non-Participating Provider	NO
1508479460	NOELLE HOUCK-MCKENNEY (Individual)	1316 W GURLEY ST PRESCOTT, AZ 86305 (928) 778-7410	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona Guardian Humana Paramount Paramount Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1508915711	ROBERT K ALDER (Individual)	107 N CORTEZ ST STE 202 PRESCOTT, AZ 86301 (928) 778-2823		Non-Participating Provider	NO
1518068733	ADAM EDWARD GABRIELLA (Individual)	500N HWY 89 NORTHERN ARIZONA HEALTH CARE SYSTEM PRESCOTT, AZ 86313 (928) 445-4860		Non-Participating Provider	NO
1558105601	LOGAN REAY (Individual)	1227 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-6684	Delta Dental of Arizona	Non-Participating Provider	NO
1558433524	J. BRETT MANGUM DDS PC (Organization)	1767 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-4110		Non-Participating Provider	NO
1558564997	GENE ALLEN (Individual)	680 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 445-9233	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Guardian	Non-Participating Provider	NO
1568697654	BENJAMIN ROBERT ABT (Individual)	5415 DISTINCTION WAY PRESCOTT, AZ 86301 (928) 350-8045	Delta Dental of Arizona	Opted out of Medicare	YES
1588322598	PINEVIEW PRESCOTT DENTAL (Organization)	680 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 445-9233		Non-Participating Provider	NO
1588620231	PRESCOTT ENDODONTIC ASSOCIATES PC (Organization)	1658 OAKLAWN DRIVE STE B PRESCOTT, AZ 86305 (928) 771-1640		Non-Participating Provider	NO
1598090086	BRIAN SCOTT KLEINMAN (Individual)	1000 WILLOW CREEK RD STE K PRESCOTT, AZ 86301 (928) 778-7181	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona EMI Health Florida Combined Life Guardian Humana Paramount Paramount Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	YES
1598722811	LEON LESLIE WACHTEL (Individual)	222 S SUMMIT AVE SUITE 4 PRESCOTT, AZ 86303 (928) 445-0582	Delta Dental of Arizona	Non-Participating Provider	NO
1619081064	FREDERICK ANTHONY FENDERSON (Individual)	3150 CLEARWATER DR PRESCOTT, AZ 86305 (928) 445-7051	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona	Non-Participating Provider	NO
1619746765	FLAGSTAFF DENTISTRY 4 KIDS, PLLC (Organization)	1306 W GURLEY ST PRESCOTT, AZ 86305 (928) 463-2292		Non-Participating Provider	NO
1619933603	SPURGEON DENTAL PC PRESCOTT DENTAL CENTER (Organization)	222 S SUMMIT AVE #2 PRESCOTT, AZ 86303 (928) 445-2440		Non-Participating Provider	NO
1629266275	JOSEPH A. SAVOINI (Individual)	1231 WILLOW CREEK RD SUITE A PRESCOTT, AZ 86301 (928) 778-5518	Delta Dental of Arizona	Non-Participating Provider	NO
1649232521	LANCE DAVID GREEN (Individual)	1225 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 445-5692	Delta Dental of Arizona	Non-Participating Provider	NO
1649312158	VAL L KUDRYK (Individual)	3103 CLEARWATER DR SUITE A PRESCOTT, AZ 86305 (928) 443-0955		Non-Participating Provider	NO
1649408576	JASON C. CAMPBELL DDS. (Organization)	139 WHIPPLE ST PRESCOTT, AZ 86301 (928) 776-1208		Non-Participating Provider	NO
1669210308	ANDREW BIONDI (Individual)	1231 WILLOW CREEK RD STE A PRESCOTT, AZ 86301 (630) 975-0445	Delta Dental of Arizona	Non-Participating Provider	NO
1679625446	PAUL WILLIAM HICKS (Individual)	108 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-6030	Delta Dental of Arizona	Non-Participating Provider	NO
1689396442	JARET SIMONSEN (Individual)	3124 STILLWATER DR PRESCOTT, AZ 86305 (928) 778-2340		Non-Participating Provider	NO
1699334789	ANSON HOOPER (Individual)	802 SCHEMMER DR PRESCOTT, AZ 86305 (928) 778-2421	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Delta Dental of Arizona Florida Combined Life Guardian Humana Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1699856732	CHRISTOPHER DOUGLAS RENEER (Individual)	1555 W IRON SPRINGS RD STE 9 PRESCOTT, AZ 86305 (928) 541-7979	Guardian	Non-Participating Provider	YES
1700952587	RICHARD MANGUM DDS PC (Organization)	1767 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-4110		Non-Participating Provider	NO
1750343844	KIMBERLY WEEKS FEE (Individual)	1316 W GURLEY ST PRESCOTT, AZ 86305 (928) 778-7410		Opted out of Medicare	YES
1750675617	JASON K BENNION (Individual)	1200 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 777-8550	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona EMI Health Humana Paramount Paramount Dental Renaissance Dental Solstice Healthplans of Arizona Inc. TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1760546071	ROBERT LOUIS DONALDSON (Individual)	815 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 445-4950		Non-Participating Provider	NO
1770507865	CRAIG JAMES LUSSIER (Individual)	500 N. HWY 89 PRESCOTT, AZ 86313 (928) 445-4860		Non-Participating Provider	NO
1780643106	JANE KATHLEEN LAMBERTUS (Individual)	1781 E HIGHWAY 69 STE 9 PRESCOTT, AZ 86301 (928) 541-1000	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Guardian	Non-Participating Provider	NO
1780702274	TOMMY CURTIS BOWMAN (Individual)	3765 CROSSINGS DRIVE SUITE A PRESCOTT, AZ 86305 (928) 445-8503	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1790159853	MICHELE A. BIBEAU, D.D.S. (Organization)	1058 FAIR STREET SUITE A PRESCOTT, AZ 86305 (928) 776-0606		Non-Participating Provider	NO
1790967610	PAUL JUAN WULFF (Individual)	1000 WILLOW CREEK RD SUITE H PRESCOTT, AZ 86301 (928) 445-3181	BannerAetna Cigna Healthcare Delta Dental of Arizona	Non-Participating Provider	NO
1801924956	ROBERT LEE STRAIN (Individual)	1227 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-7227	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1821024449	KEITH ESKANOS (Individual)	3103 CLEARWATER DR SUITE B PRESCOTT, AZ 86305 (928) 237-6456	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona DentaQuest Insurance Company Inc. Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1821146408	DANA JOE ROCKEY (Individual)	122 N CORTEZ ST STE 302 PRESCOTT, AZ 86301 (928) 235-6925		Non-Participating Provider	NO
1831557230	CRAIG NIKOLAUS (Individual)	1583 PRESCOTT VIEW CIR PRESCOTT, AZ 86301 (480) 717-2847	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare EMI Health Florida Combined Life Guardian Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	YES
1851313944	GARY WOOD TROUTMAN (Individual)	500 N. HWY 89 PSC 160 PRESCOTT, AZ 86313 (928) 776-6177		Non-Participating Provider	NO
1851513972	KEVIN MICHAEL SHUSTER (Individual)	1727 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 776-1993		Non-Participating Provider	NO
1861512444	RODNEY J BRIMHALL (Individual)	1000 WILLOW CREEK RD SUITE K PRESCOTT, AZ 86301 (928) 778-7181	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Renaissance Dental TRUASSURE INSURANCE COMPANY	Non-Participating Provider	YES
1861722563	STILLWATER DENTAL,PC (Organization)	3773 CROSSINGS DR SUITEC PRESCOTT, AZ 86305 (928) 717-8400		Non-Participating Provider	NO
1861985566	JOSHUA MICHAEL ALLEN (Individual)	815 GAIL GARDNER WAY STE B PRESCOTT, AZ 86305 (928) 445-4950	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	NO
1891244281	PRESCOTT PERIODONTICS & IMPLANT DENTISTRY, PLLC (Organization)	1229 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 778-2340		Non-Participating Provider	NO
1891426920	DAVID ALAN WHITE (Individual)	680 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 756-0910	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental of Arizona Guardian Humana Renaissance Dental	Non-Participating Provider	NO
1902245434	TORI BOWMAN (Individual)	3765 CROSSINGS DR SUITE A PRESCOTT, AZ 86305 (928) 445-8503	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Cigna Healthcare Delta Dental of Arizona Guardian Humana Paramount Paramount Dental Renaissance Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1912319187	DAVID W EDWARDS (Individual)	3103 CLEARWATER DR SUITE A PRESCOTT, AZ 86305 (928) 778-0970	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Cigna Healthcare Delta Dental of Arizona Guardian Humana Paramount Paramount Dental TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1922390822	RONALD MOORE (Individual)	222 S SUMMIT AVE PRESCOTT, AZ 86303 (928) 445-0582		Non-Participating Provider	NO
1942387204	ALBERT M. HIGGINS, DDS, PLLC KIDZAAM DENTISTRY (Organization)	1300 W GURLEY ST STE 1 SUITE ONE PRESCOTT, AZ 86305 (928) 445-8033	BannerAetna DentaQuest Insurance Company Inc.	Non-Participating Provider	NO
1962413351	SIGRID E SCHWARTZ (Individual)	1200 GAIL GARDNER WAY PRESCOTT, AZ 86305 (928) 777-8550	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona Delta Dental of Arizona EMI Health Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental Solstice Healthplans of Arizona Inc. TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	YES
1972945590	DAVID PHILLIP HERBERT (Individual)	1787 WILLOW CREEK RD PRESCOTT, AZ 86301 (928) 445-8980	Delta Dental of Arizona	Non-Participating Provider	YES
1982756755	SCOTT EDMUND HICKS (Individual)	108 WHIPPLE ST PRESCOTT, AZ 86301 (928) 445-6030	Delta Dental of Arizona	Non-Participating Provider	NO

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