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4540 E Baseline Rd. Ste. 102 Mesa AZ 85206 | |
| (480) 830-5466 | |
| (480) 830-5577 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4540 E Baseline Rd., Mesa, Arizona |
| Authorized Official Name and Position | John William Taylor (OWNER/PEDIATRIC DENTIST) |
| Authorized Official Contact | 4808305466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4540 E Baseline Rd. Ste. 102 Mesa AZ 85206 Ph: (480) 830-5466 | 4540 E Baseline Rd. Ste. 102 Mesa AZ 85206 Ph: (480) 830-5466 |
| NPI Number | 1245411644 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 11/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245411644 | NPI | - | NPPES |
| 689851 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 8386 (Arizona) | Primary |
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