| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2040 E Brown Rd, Mesa, Arizona |
| Authorized Official Name and Position | John Campbell West (MEMBER) |
| Authorized Official Contact | 4802505843 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4046 E Palo Verde St Gilbert AZ 85296-1174 Ph: () - | 2040 E Brown Rd Mesa AZ 85213-5222 Ph: (480) 250-5843 |
| NPI Number | 1528504628 |
|---|---|
| Provider Enumeration Date | 01/12/2017 |
| Last Update Date | 01/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528504628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D007997 (Arizona) | Primary |
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