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1457 W Southern Ave Ste 18 Mesa AZ 85202-4853 | |
| (480) 610-2300 | |
| (480) 833-0682 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1457 W Southern Ave Ste 18, Mesa, Arizona |
| Authorized Official Name and Position | Daniel Morrissey (PRESIDENT) |
| Authorized Official Contact | 6022536600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1701 E Thomas Rd Suite #204 Phoenix AZ 85016-7646 Ph: (602) 253-6600 | 1457 W Southern Ave Ste 18 Mesa AZ 85202-4853 Ph: (480) 610-2300 |
| NPI Number | 1821369455 |
|---|---|
| Provider Enumeration Date | 01/12/2012 |
| Last Update Date | 02/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821369455 | NPI | - | NPPES |
| 670703 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D5504 (Arizona) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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