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6755 E Superstition Springs Blvd Ste 103 Mesa AZ 85206-4375 | |
| (480) 830-5866 | |
| (480) 807-0606 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 6755 E Superstition Springs Blvd Ste 103, Mesa, Arizona |
| Authorized Official Name and Position | Jilian Porter (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 4808305866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6755 E Superstition Springs Blvd Ste 103 Mesa AZ 85206-4375 Ph: (480) 830-5866 | 6755 E Superstition Springs Blvd Ste 103 Mesa AZ 85206-4375 Ph: (480) 830-5866 |
| NPI Number | 1528530284 |
|---|---|
| Provider Enumeration Date | 12/19/2018 |
| Last Update Date | 07/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528530284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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