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1150 N Country Club Dr Ste 11 Mesa AZ 85201-2537 | |
| (480) 964-3124 | |
| (480) 964-9252 |
| Full Name | |
|---|---|
| Speciality | Dental Hygienist |
| Location | 1150 N Country Club Dr, Mesa, Arizona |
| Authorized Official Name and Position | Duane L Wirth (DENTIST) |
| Authorized Official Contact | 4809643124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1150 N Country Club Dr Ste 11 Mesa AZ 85201-2537 Ph: (480) 964-3124 | 1150 N Country Club Dr Ste 11 Mesa AZ 85201-2537 Ph: (480) 964-3124 |
| NPI Number | 1902897580 |
|---|---|
| Provider Enumeration Date | 11/02/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902897580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2827 (Arizona) | Primary |
| 124Q00000X | Dental Hygienist | H0936 (Arizona) | Primary |
| 124Q00000X | Dental Hygienist | H0657 (Arizona) | Primary |
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