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14800 W Mountain View Blvd Suite 200 Surprise AZ 85374-4795 | |
| (623) 933-5749 | |
| (623) 815-1220 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 14800 W Mountain View Blvd, Surprise, Arizona |
| Authorized Official Name and Position | Kimberly A Mack (OWNER) |
| Authorized Official Contact | 4802317020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3509 E Rocky Slope Dr Phoenix AZ 85044-7094 Ph: (480) 231-7020 | 14800 W Mountain View Blvd Suite 200 Surprise AZ 85374-4795 Ph: (623) 933-5749 |
| NPI Number | 1619091550 |
|---|---|
| Provider Enumeration Date | 03/18/2007 |
| Last Update Date | 09/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619091550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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